Brain Structures
The brain is a complex organ of the
body with several different sub-structures that govern different
functions. If you look at this picture of the human brain structures
that are compared to that of the shark, notice the blue area. The
“higher” brain functions of human beings (reason, anticipation
of consequences, ethics, morals, finding meaning in living, etc.)
all take place in the purplish blue area. Beta waves which are
associated with full consciousness in the adult are generated in the
front part of the blue area of the brain (just above where the
word “human” appears in the diagram). By comparison, sharks
don't do too much of that, but most of their lives are consumed with
pursuing prey for food, for example, and the tasks that are necessary
for survival. Much less of their brain is devoted to higher level
thought.
For the sake of simplicity, think of
everything that's not that purplish blue color in the brain as the
the parts of the brain that involve the survival response. The lower
you go (from top to bottom), the more basic the functions are, with
breathing and heart rate control centered in the bottom of the brain
(at the bulging area where the spinal cord meets the “brain stem,”
those aqua and pink areas). In the middle, between the top and
bottom (the yellow and green bits on the diagram), are the
complex structures that govern the very automatic and non-rational
survival response within the brain.
Survival Response
When faced with a real or perceived
threat, this middle part of the brain becomes very active, overrides
everything instinctively, and takes control. Blood
flow shunts away from the blue areas as the other structures kick
into overdrive to save your life (as the rational part,
the prefrontal
cortex or PFC) becomes inhibited). Studies have
shown that when a person has not had childhood trauma and when they
are able to respond to the threat which results in the avoidance of
harm, when the threat resolves, all parts of the brain go back to a
healthy baseline within a short period. The system effectively did
exactly what it is meant to do.
For a short time during and immediately
after this exciting and very emotional process takes place as part of
the brain and body's survival system, when it kicks in, it alters
consciousness, and rational thought actually becomes suppressed
somewhat. People tend to do super-human acts under such
circumstances, and their agility and responses become heightened,
creating the energy and raw emotion needed for survival. If the
person waited to think about a response, they'd never survive certain
threats because it would take too long. This is a very instantaneous
physiologic response and it is automatic or instinctive.
Post Traumatic Stress Disorder
From the study of trauma, it is known
that more people who are not able to avoid harm in response to trauma
tend to develop a chronic problem with PTSD, a condition where
this survival system remains on active alert for threats and
“runs in the background,” despite the fact that the conditions of
the original threat are no longer in place. The switch to the
whole system gets physiologically stuck in the “On” position,
remaining prepared for additional threats. The other primary
population of people whose survival system tends to remain active
includes adults who suffered trauma when they were children, perhaps
having never adequately healed from their earlier experience.
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| Jeremy Deller's Memory Bucket |
Any experience that remotely reminds
these folks of the previous trauma including subtle conditions or
memories related to the event will cause the system to turn on and go
into overdrive, just as if the original threatening situation was
taking place all over again. These triggers may not seem rational,
and triggers can even include things like a faint smell in the air
which triggers a related memory having nothing to do with the trauma.
(Read
more HERE about reverberating circuits of memory.) Those long lasting PTSD survival response is neither helpful nor productive, and it causes other parts of the brain to
basically wall themselves off from one another creating a very
predictable set of responses. In ineffective trauma processing, the activation stops in the amygdala, and never progresses for processing by the basal ganglia, causing the constant activation of the system.
Susan Grotte describes a vivid PTSD
trigger in
this post, a trigger related to being beaten on the floor of the
“blue room” at Hephzibah House. These types of vivid, detailed,
intrusive, traumatic memories that feel like they are still ongoing
(what some call “flashbacks”) are a core symptom of PTSD.
Dissociation as a Survival Mechanism
One of the other features mentioned by
Dr. Boriskin in this video
(also in the previous post) concerns dissociation. Part of what the
brain does to allow us to do things to help us survives involves the
creation of a sense of distance from the event, and this is also
governed by that non-rational area of the brain. This sense of
distance can be mild which is experienced as a feeling that things
are not real. A greater degree of it might make someone feel “tunnel
vision” or a blanking out of everything else going on around them,
except for the threat. If the mind copes by creating a greater
distance between the person's consciousness and the threat, a they
may feel like they left their body, and some people will describe
very traumatic events as though they are watching themselves in a
scene from a distance, the brain's creative way of putting more safe
distance between consciousness and the threatening experience. It
allows people to function to survive. In a healthy response
to trauma, the dissociative symptoms resolve quickly, most definitely
within six months.
After a trauma, if it is disturbing
enough, a greater degree of distance between the event and
consciousness can manifest as amnesia, as the brain and the
structures in the brain create a barrier of protection around the
memory or fail to store it altogether. This is governed by the
hormones released in the brain at the time of the event in many
cases., and the structure which converts experiences into long term
memory (the hippocampus)
can actually be altered (through interrupted development or atrophy)
by trauma, depression, and some more severe mental illnesses.
Dissociative Identity Disorder (what people used to call multiple
personality disorder) is the most rare and maladaptive form of
dissociation, the extreme of the expression of a survival response
which generally develops in cases of chronic trauma (abuse) in
childhood.
Why Certain Types of
Biblical/Nouthetic Counseling
Do Not Help and May
Aggravate PTSD
The problem with many well meaning
people concerning this failure of the survival response to shut down
is the idea that PTSD is a rational process of thought that can be
overcome by spiritual warfare or thinking good things or through
forgiveness. For the person who gets stuck in this syndrome of
survival and perceived threat, these measures actually make things
worse. Some Christians see PTSD and chronic problems related to
suffered loss or pain as sinful self-indulgence, when what we can now
observe through brain imaging and what we know from treatment and
healing of the condition, this id of rational though has nothing to
do with the process.
Suppression and Pronounced Activitiy
of Certain Brain Areas in Trauma
Based on both practical findings in
working with PTSD patients and based upon what can now be discerned
through brain imaging by following patients through recovery with
neuroimaging, we've learned a great deal about the experience and
effective treatment of the disorder.
People in PTSD tend to feel isolated
and pessimistic about the future, in addition to remaining on alert
to threat, a response called hypervigilance.
This physiologic response reduces critical thinking in response to a
trauma trigger, and affected individuals also have difficulty
concentrating in general because the survival centers in the brain
remain overactive (so they make fewer
Beta waves on EEG). And, according to researcher, Bessel
Van der Kolk, MD, a particular part of the brain also shuts down,
as though it is not even there.
There is a region in the brain in the
area of the posterior
cingulate gyrus (PCG) that activates which allows a person to
realize “Yes! This statement refers to
me.” That ability to
realize that things relate to the self is governed and located in
this particular region of the brain. It allows us to identify with
certain ideas that pertain to us and is a very active part of
experiencing empathy and compassion. When active, this area of the
brain experiences more blood flow and metabolism which can be
detected and monitored with SPECT neural imaging. In people with
PTSD, when a person is told positive messages of encouragement,
instead of the brain recognizing those positive messages as
pertaining to them which would result in lots of activity on the scan
of the brain as this area responds to those messages, this area
of the brain shuts down. During SPECT or f PET scans,
this area of the brain lies dormant.
Limitations of Nouthetic Counseling
When “Biblical” counselors come to
a person who is in PTSD and they state the laundry list of typical
encouraging statements, the person suffering from PTSD cannot
identify those statements and truths as being applicable to them.
They probably apply to everyone else, and they may be true for
everyone else, but the person affected by PTSD cannot understand on a
personal level that these statements apply to them, too. For those
who heal, I think it's nothing short of miraculous because of
this physical block in the process of understanding. But remember
that PTSD is not about what is rational but what will ensure survival
in the immediate sense.(Side Note: Read more about Nouthetic Counseling of this type HERE. I'm not a fan and take more of a fact and research based, objective, clinical approach to mental health. Scripture and spiritual warfare, what most mental health would understand as Cognitive Behavioral Therapy, plays a vital and essential role in recovery for a Christian. I don't advocate against the focus of Christian principle in recovery. But I do think that apart from direct and obvious issues resulting from sin, the nouthetic approach does more harm than good for people who are healing from trauma. I believe that Lucinda Pennington is training as a nouthetic type of "Biblical" counselor.)
When a Nouthetic Counselor comes to a
person with PTSD and lists the typical laundry list of trustworthy
Scriptures about how much God loves them, how precious they are, how
God's plans for them are good and not evil, that God offers rich
benefits of healing and reward for those who love Him and that He
cares for his wounded and precious lambs, the person with PTSD sees
these statements and ideas as having nothing to do with them.
Physiologically, their brain prevents them from really comprehending
and certainly from identifying with those statements.
What is rather curious is that when
people with PTSD who are hypervigilant concerning perceived threat,
when they are told positive statements, rather than producing
reassurance, in many cases and in some studies, the areas that govern
a response to threat and aggression become active.
That stress response also works to diminish activity in the front of
the brain – that rational, Beta wave-making part of the brain. So
rather than causing a person to be at ease, to be more positive about
how God sees them, and to shift into a healthier perspective that is
more optimistic, this type of counsel does little to help the person
and may actually make them feel much worse and sense
that they are under an additional threat. Their skepticism is not
due to prejudice, lack of effort, or even poor moral fiber on their
part, it is a physical response that is meant to help them survive a
perceived threat.
Compounding this problem is the
tendency of nouthetic counselors to see resistance to this optimism
as a willful choice to resist God's truth which they often assume
results from some deep seated sin or sinful motive. So they focus on
more rational thought and end up sending messages of condemnation to
people who are suffering from this kind of trauma. This is entirely
apart from any other aberrant theological ideas that a “Biblical”
counselor might hold that molested children are morally culpable in
their own abuse for soliciting their abuser. (Ron Williams has
referred to Lucinda Pennington as a “concubine” of her stepfather
in order to fit “Biblical” terminology, and he
and his wife taught girls at Hephzibah House that they played an
active role in soliciting sexual abuse and attention, even if and
when they were small children.)
Finding a Witness and an Ally
There are are many things that can be
done to treat PTSD that can allow for the positive encouragement of
effective Biblical Counseling to get through to a person suffering
from PTSD after they've purged the sense of threat through
desensitization and reprocessing. That involves walking through the
trauma with what Dr.
Judith Herman describes as a witness and an ally who is
experienced in dealing with complex trauma, or perhaps just a friend
who is willing to tolerate the process of supporting their loved one
in an effective way that helps them move through the experience.
Somatic therapy and reconnecting with the feelings in the body that
the mind suppresses is very helpful, as is physical activity, and
other targeted therapies for trauma like Eye
Movement Desensitization and Reprocessing all of which cause a
reflexive calming of the survival centers in the brain which brings
them back ito balance and health. Antidepressants can be moderately
helpful but offer
no cure. As Van der Kolk phrases it, antidepressants “shorten
the fuse” of a person's negative reactions and frustration, but
they are not curative. They can be helpful for clients while they
are working toward healing the root of the problem, that overactive
survival system which needs to be soothed and restored to normal
function.
Oddly enough, PTSD works to protect a
person from feeling overwhelmed by their trauma by avoidance, but
focus on working through the specific feelings and emotions of the
trauma unlocks the power of the disorder (what a nouthetic counselor
might consider “dwelling on the past in bitterness”). The
trauma response makes a person numb through dissociation, but healing
begins with facing, feeling, and moving through suppressed memories
of the event. In a safe environment with a safe person who coaches
and encourages them, the traumatized person can face what they have
been overwhelmed by and threatened by in their minds to find complete
healing.
If they were in a threatening
situation, part of self protection involves taking measures to avoid
further threat or harm, so this response is actually protective and
helps aid in survival. A person who remains in a threatening
situation will not heal from their trauma, so in this way, exploring
those feelings can help them master how to better respond in the
future. (In some Christian traditions, victims are taught to endure
the trauma and to suppress any self-protective action as a show of
virtue and submission, but this is neither healthy nor productive.
It will only foster bitterness, continued preoccupation with the
original event, and will intensify the dysfunctional response.)
What Happens in Doctrine Over
Person?
When people submit to high demand
groups that manipulate members through overt authoritarian control,
as we've learned in previous posts, they are forced into a double
bind situation where they must be honest at all costs, but also
affirm the virtue of the leader and the system. They end up
suppressing their own critical thoughts and adapt their personalities
to meet the demands of the group. People in spiritually abusive
settings and those who exit those systems exhibit a very high
degree of dissociation, as the suppression of their natural
responses and personality does pose a significant type of
psychological trauma. It is a method of adapting and coping with the
pressures placed upon them by the group system under thought reform.
How much more would a resident at
Hephzibah House be subject to dissociation symptoms if beatings,
starvation, very limited protein intake, and isolation adds to the
intense psychological degradation that they endure there?
Difficulties experienced after leaving such a situation typify trauma
and are not a matter of forgiveness or a spiritual problem. Because
of the prolonged and intense program of thought reform imposed at
Hephzibah House, the problems experienced when one leaves become
predominantly physical.
More to come.
Additional References:
- Van der Kolk, B. “The Body Keeps Score” (lecture & conversation) Pioneers in Recovery Annual Symposium 2007. Novi, MI, October 12, 2007. (Sponsored by The Meadows: Wickenburg, AZ)
- Van der Kolk B. The body keeps score: memory and the evolving psychobiology of post traumatic stress. Harv Rev Psychiatry. 1994 Jan-Feb; 1(5):253-65.
- Van der Kolk, B., Spinazzola, J. Blaustein, M., Hopper, J. Hopper, E., Korn, D., & Simpson, W. (2007). A randomized clinical trial of EMDR, fluoxetine and pill placebo in the treatment of PTSD: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68, 37-46.
- And the references noted under this previous blog post!
