PTSD can be explained - unlike the reaction of some

Activists hold a protest and rally in support of Christine Blasey Ford, the university professor...
Activists hold a protest and rally in support of Christine Blasey Ford, the university professor who accused Kavanaugh of sexual assault in 1982. Photo: Reuters
Mocking trauma survivors acts as a deterrent to the progress collectively made as a society, writes Shobit Negi. 

Christine Blasey Ford's testimony was a great teaching moment in United States history.

The testimony depicted how the human brain selectively processes life-threatening information, the emotional ramifications of trauma, the role of hormones and neurotransmitters and, most importantly, impairment in functioning subsequent to the traumatic event. It is no surprise to mental health professionals that Ms Ford's testimony triggered traumatic memories: The Rape, Abuse and Incest National Network experienced a 338% increase in hotline traffic in the first few days following her testimony.

Formation of trauma-related memories is as complex an operation as formation of any memory in the brain. Mental health professionals treating patients with PTSD often note during the course of treatment that patients tend to preferentially recall central details related to the traumatic event.

Some people who have experienced trauma continue being tormented by memories of traumatic experiences that intrude on and disrupt their daily lives. Getting "pictures" of the trauma out of their heads creates a lot of mental anguish. It is also common for traumatised people to make deliberate efforts to avoid thoughts or feelings about the traumatic event and to avoid activities or situations that may remind them of the event.

In some severe cases, avoidance of reminders of the trauma may cause a person to have "dissociative amnesia", or memory blanks for important aspects of the trauma. Dissociation is characterised by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behaviour.

Several factors influence whether a traumatic experience is remembered or dissociated. The nature and frequency of the traumatic events and the age of the victim seem to be the most important. Single-event traumas (assault, rape, witnessing a murder, etc) are more likely to be remembered, but repetitive traumas (repeated domestic violence, incest, etc) often result in memory disturbance.

Studies show that traumatic events in which there is pressure towards secrecy are more likely to induce forgetting as a dissociative defence. For example, a young girl or boy who endures repeated sexual abuse at the hands of a clergy member and has been sworn to secrecy is more likely to have memory impairment for the abuse, whereas a woman or a man who has been sexually assaulted and has a good support system in place is highly unlikely to develop amnesia for the event.

Clinical experience coupled with neurobiological evidence indicates that traumatic events are stored in the part of the brain called the limbic system, which processes emotions and sensations, but not language or speech. It is for this reason, people who have been traumatised may live with implicit memories of the terror, anger and sadness generated by the trauma, but with few or no explicit memories to explain the feelings.

Traumatic experiences affect the functioning of different brain regions, including the prefrontal cortex, which is responsible for "executive functions", such as focusing attention on what we choose, rational thinking and inhibiting impulses.

During stressful events, such as combat and sexual assault, the functioning of the prefrontal cortex is compromised due to a surge of stress chemicals. When the prefrontal cortex does not function optimally, we are less able to willfully control what we pay attention to, less able to make sense of what we are experiencing, and therefore less able to recall our experience in an orderly way.

The brain's fear circuitry mediated by the amygdala controls what we pay attention to, and it this attention that gets encoded into memory. The brain's fear circuitry also alters the functioning of a third key brain area: the hippocampus. The hippocampus encodes experiences into short-term memory and can store them as long-term memories. Fear impairs the ability of the hippocampus to encode and store "contextual information" and to encode time sequencing information.

This explains why people who have experienced trauma often have difficulty recalling peripheral details related to the traumatic event.

It does not explain, however, the callous reaction of some - including the US President - to these memory lapses. Mocking trauma survivors acts as a deterrent to the progress we have collectively made as a society.

In contemporaneous times when both men and women are willing to come forward with their history of trauma, advocacy for LGBT rights is on the upswing and females are asking for salaries on a par with their male counterparts, everyone among us needs to rethink our biases and exercise caution while judging others.

 - TCA

Dr Shobhit Negi is a forensic psychiatrist based in Baltimore.


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