Trauma by Dr Elizabeth McCardell, M. Couns., PhD

      It is timely to write about trauma. After all, we have experienced horrendous floods this year and fires three years prior and many people suffered directly and indirectly the effects of these. On social media many were saying that everybody affected have Post Traumatic Stress Disorder (PTSD). It needs to be said right here, that this isn’t true. Not all who went through these experiences are affected in this way.

     Our responses to threat are primarily instinctive and biological, and secondarily psychological and cognitive. We go into fight, flight, and freeze mode, common to all mammals. First, we enter the arousal cycle. Our muscles tense, as we identify the source of possible danger. Then we enter the mobilization stage where  our bodies begin to produce adrenaline and cortisol, the two primary chemicals that energize us to fight or flee. In the third stage, we discharge this energy by completing the appropriate defensive actions (fighting or fleeing). The fourth and final stage happens when the nervous system, no longer aroused, returns to a state of equilibrium. If we are overwhelmed by the threat and are unable to fight or flee, we instinctively employ the third action plan, the "freezing response”. Here we are in a dissociative state where our minds seem to separate from our body, but we are still highly aroused, setting the stage for high anxiety which may continue for awhile.

     I note here that PTSD is identified as the ongoing experience of trauma lasting more than three months. Less than three months, and this trauma response is identified as Acute Stress Disorder (ASD).  Not all experiences of stressful events become disorders (a very important point here). 

      According to the DSM-IV (a bible of psychiatric diagnoses), for trauma disorder to be diagnosed, the person must experience at least one of five cluster symptoms: recurrent and intrusive distressing recollections, nightmares, flashbacks, intense psychological distress in response to memories or reminders of the trauma, and physiological arousal cued by memories or reminders of the trauma);  three or more of seven  symptoms of persistent avoidance (of memories or reminders of the trauma) and emotional numbing (dissociative or psychogenic amnesia for important parts of the trauma, loss of interest in important activities, feelings of detachment or estrangement from others, restricted range of affect, and a sense of a foreshortened future); and two or more symptoms of increased arousal (sleep difficulties, irritability or outbursts of anger, concentration difficulties, hypervigilance, and an exaggerated startle response).

 

     PTSD doesn’t necessarily occur after ASD and ASD doesn’t necessarily occur after a stress event. Why is this so?  Length of duration may be a consideration, as frequency could be also, but the data is inconclusive. The anxiety response is not the same across all potentially traumatic events. Some events, such as random rape, are transient, while domestic abuse is usually repeated. Hand to hand combat can be transient, but can be repeated many times. Floods and their ongoing destruction go on for a long time, but the time factor isn’t necessarily sufficient to bring on an ongoing trauma response. Other things are at work, and we still really don’t understand everything about this stress response. Some people are more resilient than others, some have better networks and can express their feelings more openly, perhaps.

 

     Several studies have found that low cortisol levels in the acute aftermath of the stressful event and an elevated resting heart rate shortly afterwards tend to result in a stronger and more sustained stress reaction, which is hypothesized to contribute to the development of PTSD. Also an extensive prior history of psychiatric problems and/or substance abuse may make  a person  particularly vulnerable to the development of PTSD. Prior traumatic history also contributes to the development of a stress disorder.

 

     So how we live our life now matters in terms of how we respond to stressful events. Now is the time to communicate and connect with others and learn to manage our issues without abusing alcohol and drugs. Working through our anxieties and concerns through counselling is really useful in preventing the development of the debilitating conditions of ASD and PTSD because they are not inevitable. Therapy for existing trauma really does matter.

 

 

 

 

 

Nearly forgotten, but not quite

May 2018.

     Suddenly I realize I’ve practically forgotten the copy deadline for May’s article. It’s after midnight and Friday. Yikes.  I haven’t missed an issue of The Nimbin Good Times since writing for this paper in March 2009, and I can’t start now. So, what to write about?

     I’ve been thinking a lot about intergenerational trauma in recent times as I see the effects frequently among my clients. I have people coming to me with feelings of high anxiety, sleep issues, and accompanying digestive problems that are not easily simply understood from personal histories, per se, but suggest that something more is going on.  Some deep questioning from me often reveals a pattern of anxiety and depression shared by the parents and grandparents of my clients, and often shaped by war experiences and alienation from family at critical times.

     I remember working some years ago, with a man with sleep problems and associated weight issues (weight problems is identified in the literature as being associated with long term insomnia) whose mother experienced bombs going off in London as a little child. She couldn’t trust enough to sleep properly and was, and remains, always on edge and anxious. Her cortisol levels must have been through the roof.

     Cortisol is a hormone that is released in response to stress and is known as the ‘flight or fight hormone’.   It is also associated with maintaining blood pressure, and anti-inflammatory and immune processes. Interestingly, cortisol also works in tandem with the hormone insulin to manage constant blood-sugar levels, so it plays a part in digestion.  High cortisol levels are associated with diabetes, a condition my client also had.

     At an epigenetic level, my client was likely affected by the experiences of his mother a nearly three decades before his birth, and not just from the stories that she may, or may not have told her son. Epigenetics is the study of heritable changes in gene function that do not involve changes in the DNA sequence itself. Bodies don’t forget, it seems, and they hand down the generations their imbalances created by trauma. Trauma upsets nervous systems across the board that impact on the whole health of the descendents.  It becomes critical that those who seek counselling receive it with reference to trauma therapy and not merely symptom control. Good therapy is thus, in my view, a depth psychotherapy that really helps shift those levels of fright-flight-fight reactions to more than manageable levels.  Really good therapy frees up the whole self so that the energy previously captured in iterative anxious responses now becomes available for creative output and innovative work and play practices.  Clinical hypnotherapy is often useful alongside counselling in this process, but that is the client’s choice.

     I am always interested in that coming to a place of playfulness from the tensions of hardline panic because then the whole being of the self is softened, loosened, and ready for new experiences. The client can then move on to what really excites and motivates them, and, what’s more the memories of difficulties are practically forgotten.  It’s a curious thing, this forgetting, because it is possible to see that there has been fundamental change at a more than cellular level. The whole person is lively, fitter, glowing, and sort of bouncy. What was once a stuck problem story is now recounted with how things once were, with only a little bit of the pain previously experienced.

      Remembering the trauma experienced by an antecedent family member or members helps the client recognize that their own symptoms don’t necessarily reflect anything they themselves have done, or not done, and this fact often contributes to a freeing up from some aspects of the symptoms of anxiety they have felt. It shifts the experiences to a sense of something that can be witnessed as opposed to drowned in. So a chance to speak of such things to a therapist is really useful.

     Another side effect of doing therapy with a counsellor is that the changes experienced translate into changed family dynamics and even family members realign to more healthy choices. Interesting stuff. And now to bed.