Most people think of trauma as something experienced following manmade disasters, shootings, natural disasters, sudden loss or death or physical/sexual abuse, which is true, but what about the psychological trauma one might experience from more seemingly benign experiences? The type of psychological trauma that can stem from never feeling accepted by your parents, always feeling scared because there were arguments in the house, or just never feeling you were heard and understood by your family and peers. How might these experiences translate into stress and contribute to pain later in life?
Early childhood experiences shape our coping patterns and strategies for survival and participation in life. These strategies work well for a period of time, but can become a source of stress in our work, relationships and interactions with others later in life. Most often the way we behave, respond and react to situations in our lives are all happening at a unconscious level. Essentially, we may not even realize that we are under stress.
When an illness or disease shows up, people often wonder why did this happen to me? We usually seek our answers from the medical system which often only looks at our biology for the cause. A major issue arises when there doesn’t seem to be a distinct cause for our illness or pain. The medical tests are coming back normal or inconclusive. More often then not, the doctor is not asking about social relationships, work, childhood upbringing and what is actually going on in the individuals environment. They are not asking about potential sources of stress that may be acting on their body.
Individuals who experience pain are not likely to think about the connection between stress, their emotional or lack of emotional states and how their environment could contribute to their current health state. There is a very good explanation why this lack of connection may be present and it has to do with how our brain stores these experiences in the brain and body.
Memories of past events/experiences are not just stored in one part of the brain. Recalling the full spectrum of an event can be challenging for this reason. When an experience is especially traumatic, we may not even be able to remember the event at all consciously, but our body always remembers.
Let’s first look at memories we can remember-the explicit memory system.
There are 4 types of explicit memory
1) Declarative which is reciting stories
2) Autobiographical which are our personal experiences
3) Knowledge which is remembering phone numbers or the multiplication table
4) Working memories which are our problem solving, learning and idea generating memories.
Trauma experiences on the other hand are not encoded in language or explicit memory, but rather in non-verbal experience, which is in the implicit memory system. The implicit memory system has a much greater influence on our behaviours.
Memories, when they are stored in the implicit memory system cannot be retrived as memories in the form of language or a story but rather are triggered through specific stimulation. These memories are felt rather than thought.
Have you ever experienced a sense of anxiety or panic at a specific time of day? Do you find your mood changes depending on the weather season? Do you ever wake up with an uneasy feeling? Ever had a song or smell transport you to a different time in your life? Ever meet a person that just gave you a bad vibe?
This is your implicit memory system working. You are feeling or sensing something, not because of something going on in your current environment, but because your body has experienced these feelings, emotions, sensation in the past and it’s being triggered.
There are 7 types of implicit memory.
- Emotional, which is our feelings.
- Visceral (meaning organ) memory which is our internal body sensations
- Perceptual which is sight, sound, smell, etc
- Muscle memory, which is posture, movement and tension
- Autonomic memory which is the fight or flight or rest/digest system,
- Vestibular (inner ear) for balance
- Procedural memory where our habits live.
Implicit memories are only triggered when there are cues in the environment that directly or indirectly relate to an event. So for that reason, if you had a traumatic experience or an accumulation of traumatic experiences, you may not remember the specifics of the event but your body remembers and tries to communicate danger to you through a variety of sensations and feelings. If you ignore those danger signals for long enough, just like a dial, the body turns up the volume through illness, disease and pain.
So what kinds of “cues” might the mind/body give us?
- Intrusive emotions: such as anger, dread, fear or shame that is disproportionate to the current experience. Some might refer to it as over-reacting.
- Thoughts: Ruminating or predicting threat or failure (the what if thinking or worst case scenario thinking)
- Dreams: might get nightmares, flashbacks or images
- Voices or loss of hearing/vision
- Somatic (meaning body): one might experience dizziness, pain, heaviness, tingling, numbness
- Habits: Having the habit or saying yes when you want to say no, always taking care of others, not yourself, smoking, etc
So for the chronic pain sufferer, they may be experiencing flares that seems to come from nowhere. They may experience tension headaches or tingling, or increased pain when it’s cold outside. These responses may be to something in their environment; it could be a person, place, smell, or activity that is triggering a “danger” sensation. Maybe as a child they had a bad experience with a parent in the winter or maybe they were taught body sensations are bad, so they can’t stop thinking about their sensations as an indicator that something “bad” is happening.
Often times, it takes a healthcare provider who takes a holistic approach to start asking more questions about the past and present, about emotions and thoughts to help trigger the person to look more inwardly. Through compassionate inquiry, meaning looking within one’s self to try and understand why the body seems to be reacting the way it is. What might be underneath the sensations, what is my body saying NO to?
In chronic pain, to only focus on the body is not enough. Pain is an alarm and a warning system to protect us from actual or potential tissue damage. Pain also protects us from more painful emotions, such as rejection, loss, adornment, withdrawal or even financial, or workplace threat. To begin to undercover these threats you need healthcare providers that are able and willing to help you ask and work through these potential threats.
In addition to physiotherapy and other rehab professions, a psychotherapist/psychologist should be part of the team.
References:
- Accessed on Aug 24, 2018 from https://www.psychologytoday.com/ca/basics/trauma
- Janine Fisher 2017. Working with the Neurobiological Legacy of Trauma from the Neuroscience Training Summit
- Mate, Gabor. When The Body Says No: The cost of hidden stress. 2003.
Written By: Madelaine Golec, Pelvic Health Physiotherapist