This is the second in our conversation on dealing with past trauma. This is an issue very much overlooked in bipolar. The assumption is that once we learn to keep our moods under control and to handle the challenges of daily living, we become masters of our fates, captains of our souls.

But what if you come from an alcoholic family? As Shelley reports, commenting on my first post:

As the oldest, I learned to be 'perfect' in order to survive and not face the wrath of my mother. I did everything in my power not to get hurt, emotionally and physically.

She goes on to say that there has been healing in her family, “but the underlying learned thoughts and behaviors are there. Deeply ingrained.”

And from Tabby, the sensitive child in a household filled with strife, first from warring parents, then from the wrenching adjustments to life with a new father, replete with an adult stepsister who went after her mom with a butcher’s knife and threatened to burn down the house: 

I continued to have "nervous" problems, speaking only in "baby speak" when scared or upset, and I was 7 years old. Younger sis, age 6, was wetting the bed and wearing diapers.

Tabby’s suicidal depressions started soon after. At high school age, she was prescribed her first antipsychotic.

Cathryne describes a different childhood, sort of normal but with a hostile mother. Fourteen or fifteen years into her marriage, her husband attacked her with a knife, leaving her for dead. She bounced back reasonably well, but years later the depression set in. After hitting rock bottom, she was diagnosed with bipolar II.

“So was it my childhood ‘trauma’ of having a very harsh mother?” she asks. “Or was it the adult situations that living in upscale suburbia as a child left me no tools with which to deal. I don't know.”

Despite clear scientific evidence to the contrary, people still assume that trauma has nothing to do with the hard-wiring of the brain. Somehow, in our hurry to recognize that bipolar and other mental states were mediated by the biology of the brain, we forgot that our early life experience actually shapes our brains.

Back in 2002, at my first American Psychiatric Association annual meeting, I heard Charles Nemeroff MD, PhD, then of Emory University, ask this very pertinent question: "Is the biology of depression the biology of early trauma?"

Women abused in childhood, Dr Nemeroff explained, end up with a sensitized brain system, where CRF receptors are to be found in abundance. CRF is a hormone involved in the stress response. Depressed patients have high concentrations of CRF in their cerebrospinal fluid.

A study that Dr Nemeroff was involved in two years earlier found that women with a history of childhood abuse exhibited increased pituitary and autonomic responses to stress when given math tests and made to speak in public compared with the controls. This was especially true for the women with current depression and anxiety.These women exhibited a six-fold greater ACTH (another stress hormone) increase over the controls.