Sexual Trauma and the impact on Memory by Alison Woodward CTA | Dip. Clinical Supervision | MSc TA Psychotherapy | Dip. Therapeutic Counselling | UKCP accredited Psychotherapist | MBACP | IARTA Introduction When we as humans experience anything that activates our primitive survival system (Flight/Flight/Freeze or Flop) our logical, cognitive thinking switches off. This is a vital and appropriate response to experiencing something that is potentially life threatening, whether that threat is a real or perceived, to survive or get through that traumatic situation. Yet, our response (flight/fight/freeze or flop) often leaves a feeling of anger, shame or ‘stupidity’ because we didn’t react how we thought we should. Even more frustratingly we don’t fully remember what happened in a scary situation. So how come a system that is designed to keep us alive is in some circumstances so limiting? Clients often bring to therapy questions like: ‘surely I can do it differently now’, ‘why do I keep reacting like this? – it’s not happening now’ or ‘why can’t I remember? If I remember I would understand, and I could move on’. This is an understandable frustration as wanting to understand something and overcome it in some way gives hope to the future, especially if we know that we will be able to manage our emotions in a way that means we function in our here and now realities. The complexities of actually doing this however can cause intense pain and overwhelm which is excruciating for clients to bear. What is happening in our brains? The Human brain is the most complex organ in our body and has multiple layers of functionality. It affects everything we think, do and feel both consciously and unconsciously. There are many different structures to this one organ, all designed to focus or select, identify specific stimuli(s), and respond appropriately. Multi-tasking at its best and it all happens at great speed (milliseconds) to perceive and process the information we encounter! To give some context to the complexity of how our brain works Janina Fisher (2021) uses an example where if we have lost our car keys, we might try to visualise where we saw them last. Then we reconstruct frame by frame what we did after that until we locate them. This needs a number of the brain’s structure to be working together – the part that stores “visual memory”, the part that is in charge of “working memory” (the ability to retrieve past information, compare it to present data, plan or problem solve), the “memory reconsolidation” part which brings back the old information, the inhibition part to prevent unwanted memories coming in, for example, where I saw my keys yesterday (needs to be filtered). This is just a few aspects. So our brain is a lot more complex and quicker than we possibly imagine. One way to represent how our brains work when we experience trauma is to group the multiple structures together into 3 sections, known as the Triune Brain. These structures work together, like a circuit to ensure that we are responding immediately to find the best possible way to survive our experience. This is a model that was developed by Paul MacLean in 1967 but is still useful in Trauma Treatment today. Whilst the brain’s structures are in reality more complex and integrated than this representation it helps us conceptualise some of the many complex systems that are active in our daily lives. The diagram below illustrates the 3 sections and their functions clearly. Fig. 1 Understanding the Brain (From Fisher, J. 2021. P21) As the diagram shows the 3 sections have grouped together the multiple layered functions and been given different names to help us think about how and why the functions of each separate part work separately within the circuit. A lizard – for example – does not think, it just responds quickly, automatically and instinctively (Fisher, 2021) which is the function of the Reptilian brain to respond to stimulus and to keep our bodies working. The Mammalian part, or limbic system, of the brain illustrates the need for connection with others. We respond instinctively to eye contact by assessing whether we feel safe or not and are therefore emotionally responsive to others, in the same way as other mammals do. We like to be social and live in groups. It is this part of the brain that holds our feelings, emotions and memory. The final part of our brain is the Thinking Brain. The part that can reason, problem solve and hold memory for events and facts (not emotion, it is important to remember that facts are stored separately from emotion … we’ll come back to this later), this is the part that separates us from mammals and what gives us the ability to be human. In order for us to understand why we sometimes don’t remember traumatic events we need to explain a little more about the Mammalian Brain, also known as The Limbic System. This one section can be broken down further to a circuit working together to find the best response to stimulus. Figure 2 illustrates these parts in more detail. Each part holding a key to understanding what happens at the point of trauma. Moini, J., Avgeropoulos, N., & Samsam, M. (2021). Epidemiology of Brain and Spinal Tumors. Academic Press. The first element of this system is the Amygdala. Most Trauma therapists describe the Amygdala as our internal ‘smoke detector’. It is a small structure, located in the centre of the brain that is constantly scanning the environment around us for possible threats or dangers. If you have ever walked into a room and found yourself thinking ‘Something does feel quite right here’ then you’ve experienced your Amygdala working. It is vital that we have this response because when we are in danger we need to respond immediately. It is what activates our Fight/Flight/Freeze/Flop responses. If activated, the Amygdala sends a message to the Hypothalamus (the second element that is key in our response to trauma) to activate our Reptilian Brain, the part that automatically responds. Remember that lizard response – no thought just action. Our Heart Rate increases, our breathing quickens (or we might hold our breath) and our muscles tense – in short our bodies automatically prepare us to either get away (Fight/Flight) or shut down to avoid danger (Freeze/Flop). At the same time as sending a message to the Hypothalamus another message is sent from the Amygdala to the Hippocampus. This third element is where most of our memories are stored and accessed from. The problem that occurs when we are in our survival response mode is that when the Amygdala has triggered this part of the brain is not fully accessible as it’s deemed not as important at that point, because our focus is to survive not to remember. Our memories are not fully accessible at that moment as the Hippocampus relies on our Thinking brain to be able to categorise the memories with things like time, context and logic and without this input things can get a bit jumbled up and confused. This has two consequences, firstly we take a little while to work out whether we are actually in danger right now because our Thinking brain works slower than our Limbic and Reptilian brain as it needs our conscious thoughts. This is why we can feel overwhelming panic in a seemingly ‘safe’ environment – because something has triggered our amygdala and we cannot access our Thinking brain and therefore can’t rationalise that we are not in danger right now. Secondly we don’t recall things as well later on as this is the part of our brain that gives us the ability to tell stories from start to finish in logical order. Janina Fisher (2021) talks about how as humans we don’t just remember events – we remember different things in different ways. Our Thinking brain remembers sequence and logic – so we can tell the story about what happened but not necessarily how it felt. The Limbic system remembers the stimulus and the emotion attached but not the sequential information that allows us to tell a story about what happened. We might remember physical sensations, sounds, smells or snap shot images but we cannot logically understand the beginning, middle or end to an event or circumstance. This means that when our Thinking brain is switched off, because the focus is on surviving, we cannot as easily remember the sequence and logic – the memory has not been laid down in an efficient way that has effective recall and understanding. Our Limbic system remembers instead the feeling of what has happened, often that is scary and overwhelming causing flashbacks and other trauma symptoms to be activated as our Amygdala responds appropriately to the stimulus without being able to check against our Thinking brain to see whether the stimulus is actually a danger or is a reminder of something that has happened before. Treatment Not remembering a traumatic event can feel frustrating to the individual who is trying to process what has happened to them. Yet the block in remembering is often a protective factor, the memory is stored as a feeling because at the point of trauma the Thinking brain was not operating or at that moment the overwhelming need for survival kicked in and we realise that we may not be able to emotionally tolerate the experience after the event. Helping clients to understand that not remembering is a normal and highly adaptive response to trauma allows some space to reflect differently. By focusing on the feelings held in the body, so identifying what we sense in our physical form when we feel threatened, can also help make sense of what has happened. Supporting the client to interpret what they are feeling will often shift the memory to where logical thoughts can be processed which allows the trauma to be managed and processed without ever needing to recall the clear sequential memory. Alternatively, if the memory or information needs to be processed, the counselling environment often provides the safe place for the client to process their traumatic experience if and when it is remembered. The human brain is surprisingly interesting and sophisticated, so much so that sometimes we may not need to logically process that information, but the emotional shift helps deal with our challenges. Skilled Trauma therapists will work within a phased framework (Herman, 1992) with clients to create safety in the body. By teaching clients to understand the importance of appropriate survival responses and in turn supporting them to work out how to soothe their own trauma symptoms allows the Thinking brain to be accessed in the therapy room. This can help curiosity about why our memory might not be complete rather than frustration which allows the client to have permission to not remember, to recognise that the memory is there and stored safely, they can often feel it in their body due yet to the nastiness of the incident it is being safely kept away rather than it is their inability to recall it (Van de Kolk, 2014). Holding this compassion for the lost memory can soothe symptoms, the memory becoming less important to the individuals’ story as they can find their here and now frustration and symptoms reduced. Conclusion The human brain is a complex and wonderful organ that has origins in the primitive function and with the human evolution we have developed the sophisticated thought process and the frontal part of the brain, which makes us human. It is therefore inevitable that at times of crisis or trauma the brain cannot work at its full capacity or the frontal brain shuts down, as the extent of the trauma is difficult for that individual at that time. As the basic and most important human priority is to stay alive it makes sense that our brains unconsciously and without hesitation prioritise survival over all the other clever ‘thinking’ things our brains can do. By sharing and promoting a more compassionate way to think about what happens naturally in our brains and bodies when we experience trauma we can view at how we survived with pride and compassion rather than frustration and hate, whether we remember it or not. Alison Woodward CTA | Dip. Clinical Supervision | MSc TA Psychotherapy | Dip. Therapeutic Counselling | UKCP accredited Psychotherapist | MBACP | IARTA References: Fisher, J., 2021. Transforming the Living Legacy of Trauma: A workbook for survivors and therapists. USA: Pesi Inc. Herman, J., 1992. Trauma and Recovery. The Aftermath of Violence - From Domestic Abuse to Political Terror. New York: Basic Books. Van Der Kolk, B., 2014. The Body Keeps the Score. Mind, Brain and Body in the Transformation of Trauma. UK: Penguin.