Facing Trauma in Depression and Bipolar
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Your major challenge may be resolving your own traumas.
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Trauma in Depression and Bipolar. Trauma is very much overlooked in depression and bipolar. The assumption is that once we learn to keep our moods under control and to handle the challenges of daily living, we become masters of our fates, captains of our souls.
Despite clear scientific evidence to the contrary, people still assume that trauma has nothing to do with the hard wiring of the brain. Somehow, in our hurry to recognize that bipolar and other mental states were mediated by the biology of the brain, we forgot that our early life experience actually shapes our brains.
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I jokingly tell people that I raised myself and did a rotten job. More seriously, if you were to ask what the biggest challenge of my life was, I would have to say surviving childhood.
Basically, my meds got me stable while my lifestyle and coping tools got me healthy. But getting me whole demanded the courage to enter some very dark spaces and embrace a very scared child.
The Science of Trauma
At the 2002 American Psychiatric Association annual meeting, Charles Nemeroff, then of Emory University, asked this very pertinent question: "Is the biology of depression the biology of early trauma?" Women abused in childhood, Dr Nemeroff explained, end up with a sensitized brain system, where CRF receptors are to be found in abundance. CRF is a hormone involved in the stress response. Depressed patients have high concentrations of CRF in their cerebrospinal fluid.
(See The Stress-Emotions Connection.)
As kids, we are always wondering: “Is it safe?” We adapt, we learn to survive, any way we can. For some of us, this involves our brains being rewired for constant danger. Consider a child growing up in poverty:
Already by age five, according to Robert Sapolsky of Stanford in a 25-part online lecture series, there is a relationship between one’s socio-economic status and the thickness of the frontal cortex and its resting metabolic rate. The frontal cortex has one of the highest rates of receptors for glucocorticoids, which are are the last link in the neuro-endocrine loop known as the HPA axis.
Our bodies were designed to handle occasional emergencies. But throw the switch too many times and the system fails to reset to normal. Body and brain are in a constant state of alert. Chronic stress has been linked to just about every physical malady, whether as a cause, a risk factor, or a triggering event. The brain does not get off lightly, either. Entire brain systems may fail to boot up properly. We lose our capacity to think and feel and regulate our behavior.
This can result in a vicious destructive cycle. Think of the cortical areas of the brain as modulating the primitive reacting parts of the brain. The over-active back end of the brain is making insane demands (such as “I want it NOW!” or “Run for your life!”) that overwhelms the underperforming front end of the brain.
Anxiety, depression, mania, psychosis, social maladjustments - you name it.
(See Systems in Collapse.)
And here you are, age five, born into the wrong family, the wrong circumstances, already with a weakened frontal cortex. Says Dr Sapolsky: "That is one of those factoids that should have people rioting at the barricades."
Yet, some brains prove more biologically resilient – less vulnerable - than others. Let’s investigate …
In 2002-2003, researchers from the NIMH and other centers published a series of eye-opening studies that - in response to stressful situations - linked certain gene variations to heightened responses in certain parts in the brain and in turn to emotions and behaviors such as fear and depression and aggressive behavior. (See Psychiatry's Big Bang.)
Our genes may predispose us to depression or bipolar, for instance, but grow up in the right environment, free from trauma and abuse – or perhaps genetically resilient to stress - and maybe these depression or bipolar genes never get switched on.
Epigenetics is a very new field that investigates how these genes get switched on. According to a 2010 Time Magazine article, "Why Your DNA Isn't Your Destiny":
Researchers have begun to realize that epigenetics could also help explain certain scientific mysteries that traditional genetics never could: for instance, why one member of a pair of identical twins can develop bipolar disorder or asthma even though the other is fine.
This leads us to the issue of development, which, in the context of this piece, refers to anything that affects the maturation of the brain, from in utero to adulthood - to even across generations.
During the winter of 1944-45, in what is referred to as the “Dutch Winter Hunger,” the occupying Nazis cut off food supplies to the urban civilian population in the Netherlands, resulting in some 22,000 deaths. Those exposed to the starvation conditions as fetuses turned out as adults to have higher rates of obesity and susceptibility to a range of illnesses (including schizophrenia). In turn, their offspring are also experiencing higher rates of obesity and bad health.
Our genes may remain the same from generation to generation, but we are fast learning that there is a lot of variation into how they are switched on or off. In essence, a traumatic event faced by your grandfather 70 years ago may be influencing your behavior today. Boggles the mind, doesn't it?
Keep reading: PTSD and Trauma
This article is the first in a three-part series.
Published Sept 1, 20012
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