Trauma and Memory and Consequences for Treatment

In medicine, the word “trauma” is used to indicate a physical injury including an injury to the brain. In mental health, trauma is used to refer to a distressing and disturbing experience. When people talk about childhood trauma, they often refer to the long-lasting psychological injuries related to abuse or to extremely adverse experiences that happened during childhood.

People talk about a traumatic divorce, a traumatic death of a family member and traumatic traffic accidents. What makes these experiences traumatic is that they are not anticipated. A family member dying after a long and fruitful life can still come as a shock, but despite the grief, loved ones tend to make peace with the death. A traumatic death, however, is mostly due to an accident or an illness, or based on injury and often comes unexpected.

Devastating natural disasters and a pandemic like we are experiencing right now are examples of collective trauma. These types of trauma affect a large group of people which provides some form of comfort in the sense that the pain and consequences are shared. When disaster strikes, people often come to each others’ aid.

The definition of trauma I prefer is that it is “a normal response to an abnormal event that is perceived as extremely painful and upsetting”. When these events include a threat to one’s life, safety, and the fundamental beliefs on which one’s sanity is based, the experience evokes a high stress reaction that surpasses a person’s ability to cope.

It is important to include a threat to one’s beliefs, and integrity, as the worst and most painful experiences are intentionally inflicted by people onto others and often involve some type of betrayal. Let me explain this: When listing all different types of trauma, it is the painful actions undertaken by people and done repeatedly that causes the most debilitating symptoms. The trauma that is the most difficult to heal from is caused by people who were supposed to protect you and care for you.

The trauma is experienced as malicious and personal and not something survivors easily talk about. Dr. Jon Allen, a staff psychologist at the Menninger clinic and the author of a series of books on trauma refers to these types of trauma as “attachment trauma”.

In general people are resilient which means that they can heal and continue to lead a functional life. Continuous blows, however, add layer upon layer of pain and require a long time to work through all the baggage to restore one’s integrity. For most people, healing is possible, and others will at least be able to live with the past, in a similar way of living with scars that are reminders but no longer intensely painful.

What I describe above are traumatic events that impact a person to such an extent that they cannot be repressed. Let me state this in another way: People who experienced these do not forget!

We owe our brain a lot. It is the most genius part we have been given, but our memory does not work the way we often think it works. We all have had incidences during which we swore that something happened at a particular time and at a certain place and with certain people present, while later being confronted with evidence that disputes our recollections.  If a video recording were made of the event and you saw it years after, you would find that some memories were correct, while other recollections were not. What we need to accept is that every time we think about something that happened in the past, we reconstruct rather than retrieve the original story. Dr. Elizabeth Loftus, an authority on memory, a researcher and author has written extensively about this topic.

Dr. Richard McNally, a psychology professor at Harvard University, states that claims that “the body remembers” or that “the body keeps the score” are misleading and unhelpful as they imply that victims of traumatic experiences have “body memories” while their mind cannot recall the events. Implicit memory, the type of memory we rely upon when we do activities such as driving a car, that do not require us to consciously retrieve all components of the behaviour as these come automatically without much effort, also alters over time, and can even deteriorate. Even if there was implicit memory of traumatic events, there also would be conscious or explicit memory. This means that it is our mind that keeps the score.

Contrary to what some well-meaning therapists and other mental health professionals claim, the finding that people forget intense traumatic experiences, also referred to as “dissociative amnesia”, is inconsistent with what researchers have found about how our memory operates. When people experience high stress, the hormones released strengthen the memory rather than suppresses it and the part of the brain, the limbic system mainly responsible for emotions and memory, aids rather than hurdles memory consolidation.  In addition to the intensity of the traumatic event, repetition also strengthens the memory.

That people will not remember certain details of the traumatic event can be explained by the fact that people under threat focus on what is most important to them rather than on less relevant details. Children might not remember parts they did not understand at the time.

Forgetfulness is a common human experience, but forgetting a traumatic event is unlikely. Veterans with Post Traumatic Stress Disorder (PTSD) have demonstrated that they vividly remember the core of their most painful experiences.

Most people cannot remember events before the age of four. This is not an indicator of trauma, but of normal “childhood amnesia”.

When adults have times that they do not think about the abuse that happened in their past, it is not an indicator of repression or amnesia, but more of an indicator of having a better life and new and more positive experiences. People have not forgotten but are thinking about it less often and this amounts to healing.

Some people do not remember parts of the past and when being told as an adult, they feel they may have repressed these experiences, as to them hearing about these events is traumatic. A plausible explanation might be that at the time, when they were children, they did not perceive the experience as traumatic. That does not mean that they may not have been uncomfortable, confused, or scared. Hearing about it through other adults who do remember, may be traumatic for the person and they may benefit from seeing a counselling therapist, but not because this therapist needs to help them to recover repressed memories. Therapy can help them to come to terms with the new information and how to deal with it. This topic has been beautifully addressed by Dr. Susan Clancy in her book “The trauma myth” (2009).

As for treatment, Dr. Jon Allen, stresses to “let sleeping dogs lie”. As people do not forget traumatic events, therapists should never engage in trying to recover “forgotten” or “repressed” memories. However, when people struggle in life, relationships, jobs, engage in self-destructive behaviours and have symptoms of trauma including upsetting nightmares and vivid flashbacks, they are strongly suggested to seek a mental health professional who is a good fit and who helps them to make sense of what is going on. That means that the past, when relevant, will be addressed, as it provides valuable clues to where certain symptoms are coming from. Once that is done, the client learns to implement healthy coping skills and skills that are preventative and protective in nature.

Therapists feel honoured when clients trust them with their most painful memories. They are fortunate to be able to witness the journey of clients who are ready to become a stronger version of themselves. Therapists acknowledge and validate the perceptions of their clients and try to understand how the past affects their clients. The foundation of trust and openness on which successful therapy is build, forms the first step toward the rebuilding of a new future and a healthy life. If you experience symptoms of trauma you deserve a therapist who is a good fit and who is educated in what works best and what practices to use to prevent re-traumatization. 

Elisabeth Scheepers, Ph.D.

This article was published today in the free online magazine we-are-warriors-march-2021

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