Memory, fear and dissociation

(Extract from essay by Tonya Alexandri)

We know that the loss of our memory mortgages the future. Those who cannot learn from their past are condemned to accepting their future without the possibility of imagining it’ Eduardo Galeano (Uruguayan writer)

Bruce Perry, a neurologist and child psychiatrist, claims that during threat and traumatisation all areas of the brain and body are recruited and that this total neurobiological participation in the human threat response can help us understand how cognitive, emotional, social, behavioural and physiological residue of a trauma can impact us for years-even a life time. Also, the brain is remarkably capable of making strong associations between the sensory information (sounds, smells, emotions, etc) and the traumatic event and  taking a specific event and generalizing, particularly with regard to threatening stimuli; however, this remarkable capacity makes us vulnerable to the development of false associations and generalisations (Perry, 1999). For instance, years after the war a combat veteran from Vietnam may have an automatic response to the sound of a helicopter because the brain has taken a pattern of neuronal activation previously associated with fear and now will act in response to this false alarm (Perry, 1999). So due to the way that traumatic memories are stored reminders of the trauma in the present, ‘trigger feelings and sensations associated to the original event’ (Matsakis, 1996), and thus, the fear response to the original traumatic event is frequently reproduced because the amygdala becomes potentiated, and starts giving more emotional meaning to objects and experiences that would otherwise not have been perceived as scary. So, in some sense, our brain does not know the difference between a real threat and one that is stored in our mind and these reminders of the trauma or triggers ‘keep the danger signals raucously blaring and blaring like a burglar alarm tripped by someone who doesn’t know how to turn it off’ (Steinberg and Schnall, 2001).

Trauma experts hypothesize that Post Traumatic Stress Disorder (PTSD) occurs in part because the amygdala hyperfunctions and the hippocampus underfunctions (Bessel van der Kolk et al., 1996) and this takes place because the prefrontal cortex, which is responsible for extinguishing fear responses, is not active as usual during traumatisation. Furthermore, hippocampal impairment has been strongly correlated with ‘avoidance and numbing’ symptoms of PTSD, as well as, other symptoms like difficulty remembering one’s trauma, feeling cut off from others and lack of emotion.

Additionally, particular neurotransmitters released during stressful situations and traumatic events affect memory function, influencing the amygdala, the hippocampus and other regions, which results in some of the traumatic input not being usefully organized or integrated with other memories. In other words, traumatic memories are laid down differently and they include chaotic fragments that are sealed off from modulation from subsequent life experience because hippocampal activation, which is responsible for time and place, and also, gives events a beginning,
a middle and an end, is decreased when emotionally overwhelming experiences are registered by the amygdala. Haddock (2001) writes ‘the trauma hits like a hurricane, the amygdala cannot withstand the force, the hippocampus shuts down in fear, the information is not put in the appropriate file folders, and the traumatic experience floods the central nervous system’. As a result, portions of traumatic memories are stored as isolated sensory images and bodily sensations instead of parts of a unified whole (Martha Stout, 2002). This takes place because, as mentioned above, the activity of the hippocampus becomes suppressed during trauma and threat, and its assistance in processing and storing the event is not available, so the perception of the event as being over and the victim as having survived is missing (Rothschild, 2000).

This different way of storing traumatic memories also makes it more difficult for them to be recalled consciously or in full and narrative form. Bessel van der Kolk, a respected researcher in the field of trauma, claims that traumatic memories are stored in a way that does not permit survivors to know or tell their stories in a narrative form. Consequently, the memories become split off from the conscious mind and exist as fragments on the semi-conscious or unconscious level. Later on memories return; however, when they emerge into consciousness, they may not return as coherent stories, but rather in bits and pieces….. Alternatively, the story can return as ‘terrifying perceptions’, obsessional preoccupations, somatic complaints, or as a number of other symptoms (1990, cited in Matsakis, 1996). Unlike non-traumatic memories, traumatic memories can bring to the surface not only images of the incident, but the related frozen, non-released difficult feelings, sounds, smells and bodily sensations, and often people ‘will have little cognitive understanding of how the anxiety, impulsivity, social and emotional distress they suffer, are related to the brain’s creation of memories during previous traumatic experience’ (Perry, 1999). A moving example is provided by Perry of a young undersized for his age boy, with eating difficulties, who had suffered sexual abuse during his early childhood… ‘with each meal, some small part of T. relives the abuse of his early childhood, some set of deeply burned-in state memories (a type of memories that develop when a pattern of activation in certain parts of the brain occurs that is chronic or prolonged, for example, chronic domestic violence) are accessed. These (memories) rarely, if ever come to his awareness as a ‘cognitive’ memory- he may never be able to have the insight to make the association between his eating habits and his early abuse – each meal scratches at the slowly healing scars of his childhood’.

Therefore, since the trauma is not resolved and integrated in the declarative memory it can be re-experienced without our having any conscious memory because it lingers in the mind and it seems to continue to float free in time, rather than occupying its locus in one’s past and continues to intrude with visual, auditory and other somatic reality on survivors’ lives because traumatic memories are not remembered and relegated to one’s past in the same way as other life events. This process is termed dissociation, which practically means that the traumatic experience is frozen, walled off and dissociated, because the child or adult survivor cannot accommodate it. Dissociation is a coping style mobilized against pain and abuse and it allows the victim that cannot escape physically, to escape mentally and to continue in what seems like a normal day to day existence. It is a passive action of the body that cannot integrate what is happening at the moment of traumatisation because the integrative verbal action is blocked by overwhelming emotion and so the field of consciousness is narrowed. In some sense it is a shutting down of the conscious mind, which is too slow, to aid the victim’s survival. We dissociate because it is our normal response to a traumatic event and it is our way to cope with overwhelming situations because we are biologically bound to do this when threatened and overwhelmed by experience. It is all part of a natural universal human defense mechanism, a kind of emotional anesthesia, where victims ‘blank out’ or mentally divorce themselves from their painful experience (Engels, 1989). Haddock (2001) postulates that ‘the purpose of dissociation is to take memory or emotion that is directly associated with a trauma and to encapsulate, or separate it from the conscious self’. She summarily defines dissociation as a life saving, creative way of keeping the unacceptable out of sight, protecting secrets and allowing an attachment to the abuser to be maintained by allowing strong, and often conflicting, emotions to be kept in separate compartments in the mind, when abuse becomes severe enough.

However, this highly creative and adaptive human defense against threat can become maladaptive in adulthood and ‘the quality of life will be greatly diminished, if an individual continues to live as though the past and the present are the same’ (Haddock, 2001). It might at this point be useful to note that mild dissociation is part of our every day life. It demonstrates itself when we are, for instance, so engrossed in a book that we lose track of time or when we are driving automatically and we miss part of the trip. Therefore, dissociation could be viewed on a continuum and essentially ‘the difference between normal and abnormal dissociation is a matter of too much of a good thing’ and the result of our ‘two track memory system…. one track for emotionally charged material and one for factual information’ (Steinberg and Schnall, 2001). Practically, this means that all stimuli and information from the outside world are received by the thalamus, the brain’s sensory input centre, and from there it is sent either to the frontal cortex, where analytical and conscious thinking takes place or to the amygdala. It is fear and the perception of danger that determines whether information is sent to the amygdala for emergency processing or to the frontal cortex. So traumatic memories are not recorded coherently like factual memories by the thinking part of the brain since the amygdala, incapable of thought, shapes and stores these in the limbic part of the brain, which processes emotions and sensations, but not language and speech (Steinberg and Schnall, 2001). This also explains the reason why often survivors have little or no explicit memory of the trauma, but they may have implicit physiological memories of fear and pain linked to the trauma. Rothschild (2000) claims that ‘people that have been traumatized hold an implicit memory of traumatic events and this memory is often expressed in the symptomatology of PTSD, such as, nightmares, flashbacks, startle responses and dissociative symptoms’. Levine and Frederick (1997) claim that although many survivors do not remember the abuse until they become adults, this does not prevent them from having problems or trauma symptomatology. As Steinberg and Schnall write survivors ‘live with the repercussions of the event without a narrative’.

Moreover, dissociation happens involuntarily and unfortunately for people who have been exposed to severe, prolonged abuse in childhood it becomes fixed and automatic. Dissociation may involve feeling a ‘sense of detachment from oneself or from one’s body; feelings of unreality; a numbing of emotions; a sharpening of one’s senses; changes in the perception of the environment; a slowing of time; a quickening of one’s thoughts; automatic or robotic movements and a revival of buried memories as if one were reliving them’ (Steinberg and Schnall, 2001). Bessel van der Kolk identifies four types of dissociation all involving some degree of emotional numbing or mental distancing from the traumatic event, including partial or total amnesia (cited in Matsakis, 1996). Summarily, dissociation may involve disconnection of our emotions and senses and total or partial amnesia. We may also experience depersonalization or derealisation; feel like an object; feel little pain; feel as if we are floating or detached from the events taking place. Finally, in the fourth type, memory is compartmentalized and memories of different parts of the abuse are stored in different aspects within the person. Alderman & Marshall (1998) define dissociation as a psychological state in which one’s level of consciousness is altered and for some people it might involve feeling separated from their bodies and others describe the sensation of flying or floating above their bodies. In her memoir of childhood sexual abuse Because I Remember Terror, Father I Remember You, Sue Silverman, a professional speaker on childhood abuse and addiction, describes a childhood dissociative experience on the beach: ‘I sit here. I think I see myself floating away, rising up from the shoreline, as if the ocean opened its mouth in a curl of wave and released me in a spindrift. I float higher and higher, so by the time my mother reaches the spot where my body once was I know it is not me she touches’. Another survivor, Amos, describes mentally fleeing the scene of abuse:  ‘When I was being abused I simply let my conscious self fade into the background, and allowed some other part of me to take over. It was easy, I would stare at the blinds, drop my breathing down to a whisper and wander away from my body as though it was an uncomfortable suit I didn’t like wearing. When the abuse stopped I would come back to my body as a stranger; bewildered, hurt and relieved that it was all over for the moment’ (cited in Mullinar and Hunt, 1997). A survivor of early and prolonged molestation in childhood in Bass and Thornton’s anthology describes her childhood experience of dissociating. She writes ‘it became her habit to stand still and wait for the switch in her mind to transport her from a gray agony to a former calm or even happy state. She did this without knowing that she was saving herself each time, at the cost of nourishing two selves within her, each unknown to the other, each the other’s mortal enemy’. Survivors in Maltz’s (2001) book write ‘I didn’t feel what was happening during the molestation because I was outside of my body’; ‘I coped with the abuse by mentally checking out’; ‘I learned to separate my mind from my body. I recall looking in a mirror…..and hypnotically telling myself that the little girl in the mirror was not me’.

It seems that this natural defense ‘facilitates the resolution of irreconcilable conflicts, provides escape from an unbearable reality and allows discharge of difficult feelings’ (Putman, cited in Sinason, 2002)  and it provides a sense that it is not happening to the child, which allows the child to function in its every day life. More specifically, when children are overwhelmed by a traumatizing experience, ‘they dissociate mind from body so that they won’t be overwhelmed and so that their ability to cope will not be shattered’ and because children can rarely fight or flee physically when they are traumatized, they inevitably freeze and flee through the mind. They simply protect themselves with their natural psychological defenses by splitting off the experience from conscious awareness because ‘human beings are not equipped to understand abuse as it happens, nor to feel the full force of their physiological and emotional response’ (Sanford, 2006) at the time of the trauma. Bessel van der Kolk writes ‘children frequently repress painful emotions and horrific experiences as a basic survival mechanism (2002, cited in Matsakis, 1996). The traumatic incident goes to the unconscious part of the mind and ‘it becomes encapsulated by a barrier of amnesia’ (Oksana, 2001), and therefore, survivors may not remember the trauma or have large memory gaps for a period in their lives that may continue for years.

However, as already mentioned, these split off traumatic memories are held in a non-assimilated, active form waiting for resolution through re-experiencing the frozen feelings because even when we have split off the memory and have surrounded it with an amnesic barrier the fear remains and it impacts our lives because the pain and the events may be forgotten but the fear and the messages remain and one’s sense of self is organized around this fear of being re-traumatized. So, healthy coping mechanisms connected to survival at a primal level, which were essential in order to survive the trauma initially, result in developmental tasks being compromised and become self defeating in adulthood. Bratton (1998) writes that ‘the trauma gets frozen in the initial shock stage-not finished, not diminished, not integrated. It may loom large in the conscious landscape or it may be remembered vaguely, but it continues to dominate the behaviour, the feelings and thinking of the victim. It influences relationships, choices and beliefs’.