Trauma is a term the meaning of which can vary with the perspective of the investigator. For clarity of discussion, I will here set out three definitions:
- a progressive limbic dysfunction and psycho-social deskilling due to chronic alarm and threat signaling and the establishment of positive feedback loops in the autonomic and limbic systems.
- Specific historical introjects, in the form of flashbacks, either sensory or quasi-narrative, that confound present and past, and leave a state of more or less permanent disorientation and dissociation.
- Life or integrity threatening external events that instigate the first two definitions in any person.
It is the first two definitions that are relevant for this discussion, and I have termed them together as the trauma response. If, as is common, the trauma response starts early in life through early relational trauma (ERT) one is much more vulnerable to additional insults later. A childhood trauma response can attenuate if conditions improve in one's life, but a typical pattern is for the trauma response to accumulate throughout a life, either through a lessened tendency to avoid further abuse, the progressive nature of the neurological process itself, or the seemingly self-imposed trauma stemming from the impulsive choices of a person already highly traumatized. 'Moral injury' is also often imposed by extreme events, and it too calls for healing, but it is not primarily a physiological process.
The trauma response is a very special case of conditioning. Somehow, traumatic conditioning forms a self-sustaining loop that defies normal extinction. It is as if the conditioned response (the fight or flight response usually) either becomes it's own unconditioned stimulus or recruits sufficient unconditioned stimuli. Peter Levine believes that the immobilizing freeze response becomes both the conditioned response and the conditioned stimulus. Robert Scaer believes that traumatic memories have that role.
A basic and successful intervention for troublesome conditionings (phobias, obsessions) has been exposure therapy. That is, the survivor is exposed to a conditioned stimulus in a safe setting with arousal kept low. When the unconditioned stimulus (feared trauma) doesn't happen, extinction occurs, this is automatic in conditioning and is not a consciously mediated process. This often doesn't work in trauma and the reason why is as follows: In humans, memories are potent and can induce bodily states. Trauma produces both biological conditioning which is not consciously mediated, and painful associations that are consciously mediated (although they may be repressed or dissociated) The former are called signals and the latter reminders. Extinction is possible with signals because the signal can be deliberately used as a conditioned stimulus in a setting where the unconditioned stimulus and therefore unconditioned response will not occur. With reminders, the memory has become the 'new' unconditioned stimulus, (feared trauma). So with any deliberate exposure to a reminder, the memory is evoked, which is to say, reminders of the trauma actually re-perform the unconditioned stimulus, and the response is strengthened, not weakened.
The result of the trauma response is a spiral of autonomic and emotional dysregulation that produces progressive damage to the organism if not reversed. The main long-term effects are perpetrated through exaggerated swings between the sympathetic fight/flight system and the dorsal vagal 'freeze' system. The latter may have been involved as the initial response to the traumatic events, or may have been recruited as a desperate brake on the spiraling sympathetic and arousal systems. These alternating aspects of this dysregulation unfortunately undermines the credibility of the sufferers of these effects in the mind of allopathic medicine which equates variable or changing symptoms with malingering.
The trauma response disproves the simplistic adage that time heals all wounds. When healing of any sort does occur, it occurs over time. However mere time does not heal trauma. Rather, besides being self-perpetuating, trauma is progressive. Auto-immune and connective tissue diseases like fibromyalgia, for instance, are likely contributed to by the trauma response (perhaps also with the interplay of emotional suppression). In some respects, the time elapsed since the trauma response began is more a determinant of the amount of suffering than the magnitude of the original trauma. Unappreciated childhood traumas may have immense effect by midlife.
While the trauma response is different from a sympathetic shift, a sympathetic shift increases greatly the risk of the trauma response taking hold. A trauma response seems to arise when earlier efforts to regulate after a trauma are unsuccessful. This could be because the initial trauma was so great or it could be because social norms often preclude the physical acts and emotional expressiveness required to 'shake off' the early trauma response. The work of Peter Levine and David Bercelli specifically targets the trauma response through neurogenic tremors. Tremors result from the tension-regulating function of the muscles vacillating, moment to moment and motor unit to motor unit. The gamma neuron system, which is part of the autonomic nervous system is involved in regulating muscle tension, and so the autonomic system can be 'decompressed' by tremors, either arriving spontaneously ('emotionally') or arriving from the other direction from deliberate exercises that employ stretch and muscle fatigue together ('stress positions')
'Mental Efficiency': This is a concept adapted from Pierre Janet and his work with the trauma response. Despite how the name sounds in English translation, it is not really a cognitive concept but rather an energetic one, and not merely an attribute but a process. A basic part of human functioning and adaptation is the capacity first to turn needs, desires, thoughts, demands, feelings, instinct, and reflexes first into a conceived adaptive next step, and second to take that step. Without this capacity, which Janet termed mental efficiency, the aforementioned elements lose or fail to gain 'realness'. As mental efficiency decreases, reality weakens as an experience, which further impairs mental efficiency. Mental efficiency requires energy, but the energy available becomes likelier to be insufficient if the process of determining an action is too chaotic and indirect. This is an area where the 'rich get richer and the poor get poorer.' A late sign of trauma is 'poor' mental efficiency which often gets labeled laziness, passive aggression, or even attention-deficit disorder. What is necessary for improvement is increasing energy, (as in all change in the Reich and Lowen tradition) but it useful or necessary also to find some structure or practices externally that provide some steps to decrease chaos. This is the idea and history in part behind the 'milieu therapy' of inpatient mental health settings. Needless to say, homelessness exacerbates mental 'in'-efficiency, but so do probably unthoughtful institutional settings like prison and emergency rooms.
The Reich and Lowen tradition has always included the trauma response in its concept of body armor and organismic response to negating forces. However the distinct trauma pattern as seen in fibromyalgia and other 'baffling' disorders has not been central to its teaching. It is possible that the overstimulated and overly competitive trends of the last several decades have increased the trauma response prevalence markedly. Approximately two-thirds of bearers of the trauma response are women. This could be because less muscle mass on average lessens the ability of character armor to absorb the trauma, and the autonomic and limbic regulation is more affected.
Of course, trauma is where Freud started (hysteria) but he eviscerated the theory in the face of its social implications. But the study of the trauma response is the one area of psychology that has been able to both assert mind/body unity and become semi-mainstream. That is because its adherents have, unlike Reich and Lowen, avoided social criticism and any theory of human relations. It is assumed that if the initial trauma is overcome, the person will be fine, because trauma is supposed to be just accidental, and not part and parcel of socialization practices. Still, trauma theorists have explained with great benefit to a wide audience the futility of intellectual approaches toward emotional suffering. Also, they have elucidated the mechanisms by which 'biopathies' are manifested in the detailed manner that is demanded by the present day sensibility.
Last updated 12-4-16