Trauma¹

a : an injury (such as a wound) to living tissue caused by an extrinsic agent

b : a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury

c : an emotional upset

Work in neurophysiology has altered traditional views on brain development and the impact of trauma. It is now better understood how thought processes, behavior and memory are formed. The notion that the brain develops until early adulthood and then remains neurologically static for the rest of its life is replaced by the concept of neuroplasticity² which teaches that literally everything we do or get exposed to creates physical pathways between neurons or leads to pruning of existing pathways between connected neurons. The brain keeps resonating to external stimuli by changing itself on a physiological level for its entire life.

The view that traumatic experiences cause a disordered psychic or behavioral state is too narrow. A quick Google search finds many variations of an understanding that differenciates between physical damage by physical trauma, and psychological trauma as a damage inflicted to the psyche. However, it is now increasingly acknowledged that every traumatic event leads to neuronal changes which are beginning to be understood and which include temporary or lasting brain damage. In plain language: Some physical trauma leads to wounds that one can see because they are bleeding, traumatic events can inflict physical damage that is visible on a MRI or PET scan³. Survivors of severe trauma often suffer from a brain condition with biological, psychological, social and spiritual manifestations. Lacking public awareness is responsible for erroneous or plainly wrong, even moral, judgment of trauma survivors and their struggle.

Ever since the end of the Vietnam war psychology and psychotherapy grappled with what became known as post-traumatic stress disorder, or PTSD. Growing understanding about its severe impact led to efforts helping soldiers, police officers, public servants, nurses and other vulnerable groups, all of which are mostly composed of adults, with exceptions being mostly cases of catastrophes that include children. Responses comprise first-line support which includes a debriefing by a trained individual who will refer cases of visible and more severe affects to specialists. Public views often equal trauma with PTSD, the understanding of consequences of all forms of trauma and it’s consequences is too limited. A huge variety of known self-harming and self-destructive behavior is rooted in exposure to trauma. Depression and addiction medicine present examples of a growing understanding how childhood abuse affects the entire lifetime⁴ of individuals. This still evades broader public awareness: The view that depression equals weakness and addiction equals moral failure can be found in large swaths of discussions which would occasionally be sprinkled with sensational news such as about mass shootings by military veterans, for example.

In cases of mass exposure to traumatic events the coping ability of a society is limited: Man-made catastrophes and natural disasters with large numbers of victims strain first-line responders and second-line support mechanisms beyond limitations and imagination. Whilst the size of societies can act as a buffering mechanism that mitigates the societal effect of trauma on individuals, mass exposure of a community alters the entire community, not only individual members. Like in the case of individuals, these consequences can affect following generations.

It is the impact of trauma on the brain development of infants and children that gives reason to most serious concern: Significant consequences for the concept of self, self-esteem, empathy and the capacity for intimacy are amongst those aspects documented by a sound body of scientific research, at least in the Western world. Today we know that brief exposure of infants, children and adolescents to highly traumatic situations and longer exposure to less traumatic but longer-lasting events cause the same catastrophic consequences⁵. Child abuse in all forms belong to the events that constitute extreme forms of this trauma. Yet, a public understanding of the term “child abuse” is too narrow as well⁶. Immediate⁷ and life-long deviation from a healthy norm include depression, self-destructive behavior ranging from compulsive disorders to addiction, rage and anxiety and premature death in countless forms, from suicide through overdosing to cancer.

The life-long manifestations from early childhood trauma root in the specific vulnerability of the developing brain. As David Eagleman⁸ puts it: “In a newborn brain, neurons are relatively unconnected to each other. Over the first two to three years, the branches grow and the cells become increasingly connected. After that, the connections are pruned back, becoming fewer and stronger in adulthood.” It is, therefore, that early childhood trauma impacts on the neurophysiological development of the brain. This is also the reason why long-lasting exposure to trauma has a lasting impact notwithstanding its intensity.

Imagine a pristine piece of grassland. Once trespassers begin to cross this land, there will not be a random use of all possible connections between all possible points. Instead, after a short while pathways will emerge. Some of them will get more trodden over time, some remain small, some will not be used after some time. From now on trespassers will use existing paths. Just crossing the land the shortest possible way will not be a convincing option any longer. After years or decades main paths may have become roads. Within human society roads are known that exist for thousands of years, today’s super highway may have carried caravans of traders millenia ago. In the same way the developed brain builds and prunes along pathways that have formed during the initial development phase. Because the brain learns from any event, trauma throughout this formative period is especially prone to form lifelong consequences. Trauma can deform vital pathways in the brain and affects whole regions and their interaction and contribution to the whole. Pruning and building new pathways may lead to later correction, but only partially. Like a severe wound leaves a life-long scar, and pain, the same is true for the physical reality of the brain.

A second profound impact of early childhood trauma may be especially related to longer lasting traumatic events: They cause stress. Stress leads to release of stress hormones⁹. A part of the brain’s response to stress is a cascade of biochemical changes in hypothalamus, pituitary, and adrenal glands, as well as in the sympathetic nervous system. According to Louis Cozolino¹⁰, increased levels of glucocorticoids, epinephrine, and endogenous opioids are particularly relevant to a discussion of the psychological impact of stress and trauma, in that they alter attention, cognition, and memory. Long exposure of the developing brain to trauma effectively leads to that it is permanently exposed to hormones that hold functions both in the realm of pain and the realm of pleasure. A proneness to mental disorders such as depression and addiction is created early on. Likewise, the permanent activation of the amygdala within a fight-or-flight reaction causes the permanent repetition under exposure of events or situations that the brain later associates to the initially learned trigger during childhood trauma, as they do for PTSD victims¹¹. However, to the child traumas are not experienced as events in life, but as life defining¹². The effects of early and severe trauma are extremely widespread, devastating, and difficult to treat¹³.

Whilst it can be assumed that these two major consequences are culturally neutral, a third complex of trauma consequences may depend on a social context. In western societies it is well documented that early childhood trauma, especially through forms of abuse, creates psychological and spiritual manifestations: The concept of self, and of self-esteem, is negatively affected. “Abusive parenting creates a painful sense of shame, inadequacy, or superiority in children, which, if left unacknowledged and untreated, results in the prolongation of these wounds into adulthood¹⁴.” It is very obvious that the wide definition of childhood abuse often runs confrontational to traditional parenting. Sentences about the forming of character through (mild) forms of physical violence can be found in many societies, and as long as, for example, the punishment of children is still legal if approved by parents in some jurisdictions in the United States of America, this will continue. However, contemporary science and therapeutic fieldwork tell another story.