Trigger warning: Mentions of trauma impacts, child abuse, sexual assault, self harm, alcohol and drug abuse
Social media and pop psychology have popularised the phrase ‘trauma rewires the brain’. But what are the neurobiological processes that actually take place when someone goes through a traumatic experience? Once rewired after trauma, can our neural pathways be changed again as we heal? What does the term ‘trauma response’ mean scientifically? Is trauma healing a social justice issue?
To find out, TNM caught up with Dr Peter Choate, professor of Child Studies and Social Work at the Mount Royal University, Canada, ahead of his lecture on the neurobiology of trauma in Chennai on December 16. The lecture was organised by Tulir Centre for the Prevention and Healing of Child Sexual Abuse (CPHCSA).
Choate’s research includes the assessment of parents of children within state child protection services, such as the impacts of systemic bias; errors in child protection practices linked to serious injury and death; and the stigma and implications of Fetal Alcohol Spectrum Disorder.
He has also appeared as an expert witness on social work in Canadian courts as he has sub-specialised in case management and parenting capacity (including risk, domestic violence, and addictions). He has lectured extensively across the world to social workers, lawyers, the judiciary, and mental health practitioners.
What happens in the brain during a traumatic event? Does it impact memory?
Trauma can be an episode, a single event, or a series of independent events or continuous events. There is no single structure that says ‘this is trauma’.
Now, the amygdala is the part of your brain that activates the hypothalamic-pituitary-adrenal (HPA) axis. It’s related to memory formation and recall. The brain stem is sort of the primitive part of the brain we go to when we’re in tremendous fear.
When an event happens to us, there are a couple of ways in which the memory of that event might form. We can have a type of memory in which we recall only scattered pieces of the event. This is why when police interview victims of sexual assault, some may have an imperfect memory. That doesn’t mean that the assault didn’t happen. [Survivors] may have gaps in their memory, but that’s just a normal part of how memory gets formed during trauma.
Sometimes, memory forms almost like you’re watching a movie. The individual is so frightened and stuck and in the moment, that it’s like they’re filming it. The majority of people don’t do that, but we see people who do. This is confusing for social workers and police officers, because they don’t understand why one individual can remember so well, and others recall only scattered details. It’s because both types of individuals are memorising things differently.
When we say ‘trauma rewires the brain’, what is the neurobiological process that’s happening? How does that manifest externally?
When we’re in a traumatic moment, we can go into a ‘fight, flight, or freeze’ response. If we’ve frozen, we’re not really attending to what’s happening to us. So again, the memory will be imperfect.
The most important thing I think for people to remember about memory is that it is imperfect. It’s not going to be like a recording. We don’t remember things perfectly even when we’re comfortable. That’s normal.
The other thing about trauma is that the body also remembers. So emotions, bodily functions, smells, locations, and sounds are intrinsic to a body.
A person with a traumatic memory may change in a specific location, for example. You can observe their body change. This is because their body is saying, “Wait a minute, this reminds me of that traumatic event.”
Once a trauma occurs, the neural pathways associated with that trauma are fixed in the brain. It’s a myth that we can repair that.
What we actually repair is the response to the trauma. The pathway is still there. It’s not going away after the trauma. That’s why factors like smell or sight or touch can bring it right back.
What we do in therapy is to help somebody recognise the traumatic path in the brain and that it’s about how they respond when they get triggered. We can’t erase it. It’s not going to go away.
Also, sometimes, the cerebral cortex – the front portion of your brain right behind the forehead – can go offline. So there’s no singular way a person can experience trauma.
What is a trauma response? How does it show up in a traumatised person?
There are three things to remember about trauma: First, it exists on a spectrum from mild to severe. Second, the impact of trauma is also determined a bit by how the person experiences the trauma. Third, were there support systems available at the time the trauma occurred?
Trauma is a very unique, personal experience. There isn’t a single trauma response. Some people will shut down right in front of you. It’s like they’ve gone offline. It’s because they’ve actually gone into a protective space. Others get highly aggressive, and there’s a range of responses in between. You can see people who start to cry in front of you, or you can see their anxiety. For example, they may go glassy-eyed. It can show up as chest pain, or you see people who are so terrified that they may self harm.
So what I look for is, how does the person change in front of me? What were they like a moment ago, what have they become now and how’s that different?
For example, I can see it often when I’m teaching. I can see people start to tighten up or become glassy-eyed or are on the verge of tears. I have students who may get up and just walk out of the class because that’s what they need to do to look after themselves.
Another point to remember is that the trauma can combine with other forms of adverse experiences. People may engage in certain behaviours to soothe themselves. That can be alcohol or drug use. Or it can be exercise or eating or a number of things. These divert the body’s attention.
What’s an accessible way to know more on how the body recalls trauma?
There’s a lovely book written by Bessel van der Kolk called The Body Keeps the Score and a similar book by Gabor Matte called In the Realm of Hungry Ghosts. There’s also What Happened to You? written by Oprah Winfrey and Dr Bruce D Perry. Those are three very accessible books. They all have videos on YouTube as well.
In your professional experience, have you observed any specific patterns of child abuse? What challenges do you face?
We look at abuse in terms of ‘visible or invisible’ and ‘seen or unseen’. Some cases of child abuse can be visible, but people won’t notice it unless they really look at the signs. Or it may be visible, and may be seen by someone, but the person does not report it to the authorities—essentially they deny seeing it. Then there are cases in which the abuse is happening in families that are so insular that no one sees it.
What we know from experience is that a substantial number of child abuse cases are ‘seen’ (It must be noted that abuse does not always have physical signs) more than they are reported. We have countless cases from across the world in which families, institutions, or communities should have ‘seen’ the abuse, or probably did see it, but did not report it.
In the Rotherham child trafficking case, for example, there was no question that everyone knew it was happening, but were too afraid to report it. So it kept going on and on. Then there was the Jefferey Baldwin case in Canada. Not ‘seen’. It could have been ‘seen’ had people looked closely, but the child’s grandparents, who were accused, did a very good job of hiding the abuse. Rarely do we have a case that could not have been ‘seen’. If people really look, they can see the flags.
A child could be in a situation in which they’re experiencing some of all of this. For example, it may be a situation that’s visible, but nobody responds because they choose not to ‘see’. There are invisible cases that stay invisible. But sometimes, something happens that makes it visible. A child reports. Or there’s an unexplained injury, something to make the abuse visible.
The most important thing we can do is to get people to look, because when you look, it becomes more visible. In the vast majority of cases, if someone was paying attention, they would have ‘seen’ the abuse. There are very few cases that are so hidden that they can’t be ‘seen’.
Since social marginalisations can cause trauma, shouldn’t healing from trauma also be a social justice concern? Being someone involved in policy making, could you speak about trauma as a social justice concern?
Yes, very much so. Around the world, child protection services are under-funded. If child protection was a priority, we would fund it. Fifteen percent of children in foster homes in Canada are moved there because they’re not safe with their families. The remaining 85% of Canadian children in foster care are there because of neglect. The share of children removed to foster care due to safety concerns and neglect may vary across the world, but not very drastically.
Children are often neglected due to an unavailability of social determinants of help, such as housing, medical care, and education. This lack of social and economic support causes so much difficulty that families won’t have the emotional resources to support the children.
The most logical answer to the problem is to support families. If we were to support the family properly, we would not need to move these children. But we remove them because it’s easier than building systems of support, even though frankly, it’s cheaper. Let’s not forget that removing a child from their family is also cause for trauma.
In Canada, this [lack of support] is because of a neo-liberal belief that people are responsible and need to pull themselves up, and society will intervene only when it is absolutely necessary.
But also, the history of child protection is founded in the belief that the primary unit of society is the family, and that authorities must intervene in a family only in extreme cases. So there’s already a high threshold. When this threshold gets raised, less child protection is funded. This means that the abuse has to be severe before there is any intervention, as there aren’t enough resources.
If every child matters, then we would have food on the table in every home, we would have quality health care and educational resources available to every child, and we would have quality housing, including in rural and low income communities.