storytelling~the healing path: trauma is the great silencer

The practice of narrative medicine encourages healthcare providers to explore the patient's whole story, not just the timeline of their symptoms. It allows time and space for patients to reflect on their lifestyle, cultural roots, socioeconomic status, religious beliefs, and the presence or absence of supportive relationships...whatever might have had an impact on their health, and their ability, or lack of ability, to heal.

"It is more important to know

what sort of person has a disease

than to know what sort of disease a person has."

~Hippocrates~

There's just one problem with this approach. We never learned about the problem of trauma and how it affects memory. How it affects the way we process and navigate terrorizing or horrific events--the emotional and physical aftermath of war and natural disasters, serious injuries, difficult hospitalizations, domestic violence and child abuse, among others. How trauma can trigger intense emotional reactions years later so that even early childhood trauma can lead to physical, psychological, and emotional disturbances in adulthood. Why it is sometimes impossible to access those memories, and what makes it so hard to put them into words. In other words, unless you recognize the sign and symptomss of trauma, an important part of the narrative will still be missing.

"Traumatic events are almost impossible

to put into words."

~Bessel van der Kolk~

Trauma is the great silencer. As demonstrated on fMRI images, trauma activates the limbic area, or emotional brain which includes the body's alarm system. Years later, when people encounter images, sounds, or thoughts related to their trauma, it triggers a cascade of stress hormones that raise blood pressure, heart rate and oxygen intake, preparing the body for fight or flight, even though no current threat exists. At the same time, trauma decreases activity in Broca's area, one of the speech centers of the brain. When Broca's area shuts down, you cannot put your thoughts and feelings into words. Years later, traumatized people have enormous difficulty telling the story of what happened to them.

"You'd be surprised what lengths

people will go to

not to face what's real and painful inside them."

~unknown~

This is the missing piece in narrative medicine training, the part of the patient's story that will never emerge, because it can't. Memory is shut down. Speech is cut off.

The bad news is most physicians don't know this, so they can't help their patients heal from it. They aren't trained to recognize and explore the signs and symptoms of remote trauma, nor do they know how to treat it. The result is that these patients end up with a multitude of inaccurate diagnoses including, but not limited to depression, anxiety, ADHD, oppositional defiant disorder, and borderline personality disorder. Then they are prescribed a slew of medications in a futile effort to regulate their behavior and responses.

The good news is it can be treated. Patients can be taught to access painful memories and to assemble them into a coherent history without being emotionally overwhelmed. Only then can healing begin.

If you, or someone you know, or a patient you are treating tends to fly into a rage for no justifiable reason, or is anxious even when things are going well, or shuts down in social situations, or has been in therapy but hasn't made any headway, the cause may relate to unresolved trauma, and it may take a topnotch specialist to crack the case, and to work through the problem.

If you're interested and would like to learn more, there are plenty of resources available. Check out "Developmental Trauma Disorder" online. These are books that helped me a lot: