TRAUMATIC MEMORY: NEW RESEARCH


In dealing with survivors of trauma, those involved have split into two mutually suspicious and polarized camps. Trying to make up for years of neglect of traumatized clients, some clinicians have abandoned neutrality to believe all "memories." At the other extreme, members of the False Memory Syndrome Foundation have blamed therapists for planting memories of abuse in the minds of vulnerable clients. Neither side understands how the brain stores memory. Neither side bases its opinions on new knowledge about the difference between traumatic and non-traumatic memories.

Many social workers are hampered by the fear of ending up in nasty lawsuits if they keep clients company though the painful process of retrieving traumatic memories. Irate families are coming forward in alarming numbers to charge helping professionals with creating false memories of abuse in the minds of their adult children.

To support social workers in overcoming their fear of lawsuits, and to enhance their effectiveness in helping clients, this paper presents an overview of new neurological and biochemical knowledge which is essential to understanding traumatic memory. It then continues with an exploration of some of the implications of this scientific perspective.

Three leaders in the exciting new research area of the effect of trauma on memory are: Robert Sapolsky, Department of Biological Studies, Stanford University; Bessel van der Kolk, Trauma Clinic, Harvard Medical School; and Bruce Perry, Chief of Psychiatry, Texas Children's Hospital.


ROBERT SAPOLSKY

Robert Sapolsky's work explores the effect of stress (long and short term) on the brain, and the on the brain's capacity to remember. His research indicates that long term stress has neurodegenerative effects on the brain.

Sapolsky says that stress is double-edged and paradoxical where memory is concerned. We do not just passively imprint whatever is happening around us. Our emotions selectively determine what we remember, what we forget (repress) and what we never remember (dissociate).

Short term stressors actually improve memory functioning. Heightened emotion improves our memory for details under certain circumstances. On the other hand, long term and traumatic stressors may actually damage the neural capacity of the brain to store memory. This neurodegeneration may be permanent and affect the recovery process of the individual in therapy.

VAN DER KOLK

Bessel van der Kolk makes clear the difference between traumatic and non-traumatic memories and describes which parts of the brain remember each. His work details how intense emotional reactions in trauma cause memory to break up and be stored as somatic and/or visual memories.

Van der Kolk explains how the brain handles memory and how long term stress interferes with the brain's ability to store memory. The parts of the brain involved in receiving a memory are the thalamus, the amygdala and the hippocampus. All these parts are involved in the integration and interpretation of incoming sensory information.

The thalamus receives the input and hands it on to the amygdala which determines, according to the emotional response, whether and how to store it as memory. Moderate to high activation of the amygdala enhances long term memory. However, excessive stimulation of the amygdala interferes with hippocampal functioning, which means that the memory does not get stored in the normal way.

Van der Kolk distinguishes between what he calls "declarative" and "non-declarative" memories (1994, p.258). Declarative or explicit memories are memories of facts and events. Non-declarative, or implicit memories have emotional associations and lack concrete facts. Trauma interferes with declarative memory, that is, conscious recall of experience, but does not inhibit implicit or non-declarative memory. Thus, we still have sensorimotor sensations related to the experience, as well as conditioned emotional responses to anything that reminds us of the original trauma. Chronic exposure to stress affects both acute and chronic adaptation. It permanently alters how an organism deals with its environment on a day-to-day basis and interferes with how it copes with subsequent acute stress. (van der Kolk, 1994, p.256)

Traumatic memories do not get integrated and interpreted in the usual fashion. Memories that are too traumatic to be received by the brain in the normal way break up like pieces of a jigsaw puzzle; some pieces going into somatic impressions and some into visual images such as flashbacks and nightmares. These images are relatively indelible, but can be modified by feedback from the prefrontal cortex. Unless the necessary cognitive influences take place, usually through psychotherapy, the body memories and conditional responses may remain in the body forever, as fresh as when the original trauma happened.

People who have been traumatized and have had these neuro-degenerative changes to the brain do not respond to pressure the way other people do. Under pressure they may feel and act as if they are being traumatized all over again. These traumatically created "emotional memories are forever," (van der Kolk, 1995, p.256) and new information or pressures are processed through that filter.

BRUCE PERRY

Bruce Perry researches how trauma effects a baseline state of reactivity to stress and determines how quickly one's body chemistry returns to normal once the stress is over. Perry's work shows how easily a person is re-traumatized once the normal mechanisms of stress recovery have been disrupted by traumatic experiences.

Perry (1994) address both Sapolsky's finding of neuro-degeneration in the constantly traumatized brain and van der Kolk's interest in how chronic exposure to stress permanently alters and interferes with the neurological system's ability to cope with subsequent stress. He explains that the whole body will respond to stress by moving along a continuum of vigilance, alarm, fear and terror. As a person moves along the continuum, more and more of the body's responses to stress are involved. Resilient people do not move far along the continuum, and, once perceived danger has passed, quickly return to a resting state. However, if people have been traumatized often and early in life, they zoom to the top of the continuum and take longer to settle back into a normal body state.

Someone who moves too fast and too far along the continuum of vigilance, alarm, fear and terror will likely dissociate somewhere along the scale. Dissociation, "the separation of an idea or thought process from the main stream of consciousness" (Braun, 1988, p.4), is a key phenomenon to understand in dealing with traumatic memories. Perry says that when many people get to a certain state of arousal, they have the capacity to remove themselves from the event using dissociative adaptations.

When a person has dissociated, memories of events that occurred when the person was in that state are stored separate from the normal state of consciousness. This is different from repression because the event has never been truly known by the subject, so the memories are not actually "forgotten." Rather, the "memory" has not been stored in a way that is accessible to normal conscious recall.

Perry makes another valuable contribution to our understanding of trauma and memory when he describes the brain as organized in a hierarchy. Different parts of the brain mediate different functions and are sensitive to different kinds of experience. The brainstem develops first, while still in utero. Just above this and next to develop, is the midbrain. The brainstem and midbrain are sensitive to anxiety and arousal. These parts of the brain have none of the later developing cortex's capacity for abstract or concrete thought! No wonder, then, that the memory which has been stored in the more archaic parts of the brain cannot be retrieved and laid out in rational form.

IMPLICATIONS
The implications of this research are profound for all of us; for survivors of childhood trauma, for their helping professionals and for the intelligent public caught up in polarized debates. How can survivors appropriately evaluate their own memories of abuse? How can therapists best keep company with their clients without either being suggestive and leading in their inquiry, or colluding with the client's and society's denial around childhood trauma? How can everyone else sort through these complex issues to make sense of this decade's widely divergent views on the accuracy of recovered traumatic memories?

In her book, Unchained Memories (1994), Lenore Terr offers some interesting criteria for determining whether such a memory is false or actual.

Good clinicians base their diagnoses of early trauma on very specific posttraumatic symptoms. Survivors of childhood sex abuse generally have specific problems about sex. They have specific problems about control, often falling under the influence of others, such as their friends, teachers, camp counsellors, and, ultimately, lovers. As children, they play strange games of imagination, often with a sexual tinge. They get aches and pains in the lower abdomen or on the skin. They develop bothersome anesthesias of sexually related anatomy. They feel intensely ashamed. They do not plan on having children of their own, or, if they do have children, on raising them well. (p. 172)

Terr's criteria along with the recent research gives social workers new guidance for treatment. Understanding that traumatic memory is not stored intact, we should not press for all the details of traumatic experiences. Rather, we should realize that the somatic symptoms, the imagery arising in psychotherapy, the quality of the nightmares, the phobias and fears, together with the unusual behaviour patterns, all point to the likelihood of prolonged intolerable stress. The body remembers even if the brain does not. We begin to see the body's responses as signs of probable abuse.

It is important, then, to direct our efforts toward helping clients deal with what they are experiencing. Cognitive understanding of trauma effects is vital so that the client learns to tolerate and calm the anxiety, rather than exacerbating it by responding to the fear with even greater fear. We need to help our clients recognize why they lack resilience and why their fight or flight response is so easily triggered by seemingly insignificant external events; to help clients explore how they dissociate along the continuum of stress and how they can minimize the damage done by trauma.

Not everyone who lives through trauma is left with permanent neurological damage. Some people seem to experience trauma without any of the signs and symptoms described by the new research. Our understanding of trauma is still in its infancy as more and more clinicians and researchers explore this complex area. There is much we do not yet understand about the effects of trauma on different individuals.

When we are working with clients who manifest the signs and symptoms of trauma described by the current research, we would do well to keep in mind the neurodegenerative effects of trauma on the brain. Then we can stop trying to change the trauma survivor's response to fear and anxiety and get on with accepting these reactions as inevitable. We can recognize that therapy itself is stressful and watch for and work with the client's dissociative behaviours. We can keep in mind how frightening these traumatic memories are for our clients, since the emotional impact of the childhood memories remains unaltered by adulthood. Even if our clients appear calm in therapy, we can remind ourselves that survivors are experts at concealing their fear and anxiety, and shape our therapeutic interventions accordingly.

Most survivors receive van der Kolk's news that "traumatic memories are forever" with mixed feelings. On one hand there is disappointment that total healing may never happen. On the other, most survivors feel relieved to know that their symptoms of post-traumatic stress disorder are not due to any inherent weakness of character. Rather, their overly active stress response, their tendency to dissociate, their bizarre nightmares, fantasies and somatic complaints are due to damaged neuroanatomy and biochemistry.

Learning that the prolonged stress of trauma permanently alters how an organism deals with its environment on a day-to-day basis and interferes with how it copes with subsequent stress, survivors realize that if the abuse had not happened, they would not be dealing with all these extra burdens in life. Life would be much simpler. They would not have to work so hard at avoiding triggers and stressful situations. They could lead more spontaneous, less restricted lives.

It is important for survivors to understand their own continuum of dissociation, beginning with numbing and progressing through to full dissociation when there is no memory of an event. Typically, survivors describe numbing as having "a head full of white noise." They say: "I can't think." "There's nobody home." This is troubling and frightening to them.

Dissociation serves a purpose, though, and helps the survivor get through intolerably stressful events. Therefore, it needs to be recognized for what it is - a life-serving adaptation which helps the person get through what would otherwise have been too painful to endure. Dissociation does not occur unless it is necessary for survival.

Above all, survivors need to use this new research to develop a skilful, compassionate way of being with their own woundedness. For example, nothing can be done to prevent an over-active startle response. However, once the alarm system is set off, how the survivor deals with panic makes all the difference. Will she get furious with herself, berating herself for this latest humiliation, thereby exacerbating her sense of shame and self-loathing? Or will he turn his attention gently and comfortingly to the part of him that is damaged by past incidents beyond his control?

CONCLUSION

It is only through understanding the lasting effects of trauma on memory and on consequent behaviour that as a society we will bridge our polarization and suspicion where recovered memories are concerned. Those who say, "But how could you forget something so awful?" need to understand the place of neutrality in the face of the complex, non-declarative memory. And those who struggle with their own memories of childhood abuse will have to be comforted by understanding the neurological/biological nature of their specific physical and emotional reactions to life.

References

Braun, B.G. (1988). The BASK model of dissociation: Dissociation. 1(1), 4-23

Courtois, C. (1988). Healing the incest wound: Adult survivors in therapy. New York: W.W. Norton.

Herman, J. (1992). Trauma and recovery. New York: BasicBooks.

Herman, J. (1994). Father-daughter incest. Cambridge: Harvard University Press.

Perry, B. (1995). Childhood trauma, the neurobiology of adaptation, and "use-dependant" development of the brain: How "states" become "traits" Infant Mental Health Journal Winter, 271-291.

Sapolsky, R. (1994). Stress and neurodegeneration. Keynote address at The 11th International Conference on Dissociative States. Chicago.

Terr, L. (1994). Unchained memories. New York: BasicBooks.

Terr, L. (1990). Too scared to cry. New York: BasicBooks.

Van der Kolk, B. (1994). The body keeps the score: Memory and the evolving psychology of post-traumatic stress. The Harvard Review of Psychiatry. Jan-Feb, 250-260.