This is the eighth and second-to-last installment in our conversation on past trauma. What kicked off this series was a comment from a reader who challenged me to recognize the past trauma in my life. Along the way, I was guided by readers who possessed both the eloquence and courage to share their experiences in surviving trauma and abuse.
Not uncoincidentally, over the past two years, I have been engaged in a form of therapy with my brother, which involved the two of us talking about our childhoods over a beer or two. This formed the basis of my first piece - A New Conversation - where I concluded:
Basically, my meds got me stable while my lifestyle and coping tools got me healthy. But getting me whole demanded the courage to enter some very dark spaces and embrace a very scared and very fragile boy. It is still an ongoing process.
In my second piece - The Conversation Continues - I noted that, contrary to public misconceptions, trauma is not just a phenomena of “the mind,” divorced completely from the biology of the brain. Early life experience actually shapes the brain. For instance, women abused in childhood end up with a sensitized brain system, with a high concentration of CRF receptors. CRF is a stress hormone that figures in the fight or flight response.
In a sense our brains have been wired for constant danger. This vulnerability, assisted by our genes, leads to anxiety, depression, mania, psychosis, and all manner of other things that can go wrong.
In my third piece - What We are Up Against - we looked at how the cumulative effects of living in a constant state of siege, where the body is perpetually primed for fight or flight - sets off a series of processes that result in brain cell damage, typically to the point that these neurons are in no shape to handle the next crisis. Entire brain systems may be compromised. We lose our capacity to think and feel and regulate our behavior. As I concluded:
And there you are, age five, born into the wrong family, the wrong circumstances, already with a weakened frontal cortex.
In Part Four - Genes, Epigenetics, and Development - we looked at why some brains may be more resilient to trauma than others. Essentially, this involves a complex two-step between biology and environment. A series of studies published over 2002-2003 linked certain gene variations to how we respond to whatever life may happen to throw our way. In many cases, depression may be the result of a genetically vulnerable brain overwhelmed by current life stresses or past traumas.
Epigenetics and development involve how these genes get switched on or off. In other words, even though we may be genetically vulnerable to stress and bipolar, in the right environment these genes may never get activated to the point of turning our brains against us. But heaven help if we are born wrong. Even in the womb, we may be exposed to gene-triggering stressors. Mind-bogglingly, our epigenetic hair-triggers may be transmitted across generations.
In Part Five - we explored the Bipolar-PTSD connection, where our brains become oversensitized to the point that our entire world feels unsafe. Fifty percent of those with bipolar report incidents of childhood trauma. Throw in adult trauma and the stresses of modern life and we can include just about all of us. This raises the obvious question that perhaps we should be putting more emphasis on treating our trauma (but noting that one trauma treatment - antidepressants - may make our bipolar worse).
The people to talk to about trauma are those specializing in PTSD. The catch is that the diagnosis is narrowly written to the point of exclusion, which we went into in Part Six - The History of the PTSD Diagnosis. Our knowledge of PTSD came out of observations of soldiers mentally incapacitated by the horrors of combat as opposed to civilians exposed to everyday life traumas such as auto accidents.
This historical anomaly has blinded researchers and clinicians to the biological fact of how trauma affects all of us, regardless of cause. Compounding this is the fact that bipolar specialists and PTSD experts don’t talk to one another, leaving us largely to our own devices.
In Part Seven, we focused on one of the PTSD therapies, EMDR - eye movement desensitization and reprocessing - which has a high success rate. The catch is that the measure of success for these therapies is in reducing PTSD symptoms, not bipolar symptoms. For this, we have no published studies. It stands to reason that any therapy that can help resolve trauma should also do wonders for bipolar, but this may not always be the case. For instance, delving into trauma issues too soon - even under the care of a competent therapist - may have a destabilizing effect on one’s bipolar.
Thus, extreme caution is urged. On one hand, it is fairly apparent that - for many of us, at least - we will not be successful in managing our bipolar until we come to terms with our past trauma. But first, it seems, we need to have some measure of control over our bipolar.
This leads to the critical question: When is it the right time to engage in the process - in effect, to lift the lid to your early life and start poking around with a stick?
More to come ...
Published On: July 21, 2012
Living With6 Chronic Condition Guidelines to Live By
Facing the challenges5 Rules for Bipolar Relationships