I am writing on Sunday morning following my usual Sunday morning routine of listening to On Being with Krista Tippett. Sunday, August 2, 2015 her guest was Dr. Rachel Yehuda, a neuro-scientist who was one of the first students of psychology to be given the choice to get her PhD in neuro-science or psychology. Her particular field of study is epigenetics. Early on in her research, while still working on her doctorate degree, she began to study how the behavior of genes are affected by changes in the environment and behavior. She has specifically focused on the affects of experiencing traumas such as the Holocaust, 9/11, and combat. There are many aspects of the work she and other neuro-scientists have done which has significant implications for how we humans define and learn to cope with trauma.
As a person who was raised in an observant Jewish family in Cleveland where there were a number of holocaust survivors living, she was particularly interested in such traumas a the holocaust and what changes trauma might have on the functioning of the person who experienced the trauma and the children of that person(s) One of the early findings was trauma survivors could have lower cortisol levels. Cortisol level is important for a number of reasons.
“Blood levels of cortisol vary dramatically, but generally are high in the morning when we wake up, and then fall throughout the day. This is called a diurnal rhythm. In people that work at night, this pattern is reversed, so the timing of cortisol release is clearly linked to daily activity patterns. In addition, in response to stress, extra cortisol is released to help the body to respond appropriately.
The secretion of cortisol is mainly controlled by three inter-communicating regions of the body, the hypothalamus in the brain, the pituitary gland and the adrenal gland. This is called the hypothalamic-pituitary-adrenal axis. When cortisol levels in the blood are low, a group of cells in a region of the brain called the hypothalamus release corticotrophin-releasing hormone which causes the pituitary gland to secrete another hormone, adrenocorticotropic hormone, into the bloodstream. High levels of adrenocorticotropic hormone are detected in the adrenal glands and stimulate the secretion of cortisol, causing blood levels of cortisol to rise. As the cortisol levels rise, they start to block the release of corticotrophin-releasing hormone from the hypothalamus and adrenocorticotropic hormone from the pituitary. As a result the adrenocorticotropic hormone levels start to drop which then leads to a drop in cortisol levels. This is called a negative feedback loop.”
Yourhormones.info
As with all pars of the human system balance or homostasis is very important. Too much or too little cortisol can have adverse affect on how the body functions.
Not only had Dr. Yehuda and her colleagues discovered that the genes can be turned off and off in survivors of trauma but also children of survivors can have long term or permanent changes in both the genes themselves and in the switches of the genes. It is possible that the fetus of those women who are pregnant while experiencing a significant trauma, I.e. pregnant women who experienced 9/11, could be affected genetically (I think that I have this information correct.)
In recent years mental health professionals have been increasingly aware that it is important to ask new clients/patients about their trauma history. A trauma history can includes such obviously significant events as 9/11 or combat experience as well as acute, permanent injury, rape or other life changing events. How one experience an event may determine the severity of the affect on the genetic functioning of we humans.
In the seventies I began to work with clients who had experienced what came to be labeled as post traumatic stress. Although this condition was not new, the label was not included in The Diagnostic and Statistical Manual of Mental Disorder until 1980.
Since that time the label of PTSD has been more widely applied to the symptoms experienced by people who have experienced a variety of traumas. Not all people who experience a significant, negative event have symptoms of PTSD. The question of how the body processes events and how the symptoms of that processing can be treated is of ongoing interest to many clinicians. It has long been noticed that some people seem to experience very traumatic events without having long term, negative, debilitating symptoms. This is not to say that they do not have scars but they are able to move forward with a relatively enjoyable life. Gloria Emerson was one of the authors who began to interview and examine individuals who experienced significant loss and stress in combat situations in the Vietnam War and still function well. As I recall she discovered that those who did not report long-term significant symptoms of PTSD had the following characteristics:
· Without the use of alcohol or other drugs which put them in an even more dangerous position, when they had a break they could enjoy a sunset, a conversation with a friend, a letter from home, good food or some other positive event. That is, they did not just focus on negatives.
· They had an active support system.
· They had a sense of purpose or career goal when they returned from the combat experience.
Dr. Yehuda also talks about some of the positive affects of Jewish rituals, which remember or honor past events. Past tragedies or triumphs are not forgotten or put in the closet. Not only do such rituals honor the past event but also they set a particular time to do so. It is not ongoing.
More recent treatment of PTSD by mental health professionals has focused on treatment techniques such as Cognitive Processing Therapy and Prolonged Exposure Therapy. There is more appreciation for the fact that running from, not talking about or not allowing the body to re-experience the trauma has a very negative affect on one’s health. On the other hand, one is not encouraged to think of oneself as a victim who is so damaged for life they cannot function.
Dr. Yehuda briefly mentioned the fact that some believe that both the books of Lamentations and Song of Songs in the Jewish and Christian Bible were written by the same author. I could not find any evidence of that, but I appreciate the reminder of what I have long believed. It is important to both express the pain and the grief of the trauma and it is important to allow ourselves to experience the positives, which are still possible. It is not either the negatives or the positives of life. It is the ability to allow one to experience both.
The experience of trauma is very individual. Whether we use that word or another, it would seem that we need to learn from our religious traditions that it is important to name and honor the trauma without defining oneself by the trauma. Whether one is a respiratory therapist, a mental health counselor, a physical therapist or a general physician we need to be more intentional about encouraging patients and clients to talk about their trauma without defining themselves as the trauma.
The 12 step program used by many to recover from various addictions clearly recognizes in steps four and five the importance of acknowledging one’s past, sharing it and moving on.
We also need to recognize that the human body is itself an interactional system and it operates within a larger interactional system. The more we discover about the human body the more awed we are by the extent to which even genetics and genetic switches are affected by and affect the functioning of the human body.
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