From my first day as a floor nurse I was confronted with the effects of trauma. Nurses really don’t get great training in psychiatry. That’s another passion of mine, but one I’ll save for another day. I kept seeing my patients having these behaviors and reactions that I couldn’t understand because they didn’t seem appropriate for the situation. I remember, before I had any real training in psychiatry, saying to a doctor that I know and respect, “You know it seems like all these patients with borderline personality disorder have extensive trauma histories, do you think there’s a connection?” If our positions were switched now I would probably have turned this into a teaching opportunity, but she just patiently smiled and said “They’re the same people. The Venn diagram is just a circle.”
I don’t know if that was the moment I decided to specialize in trauma or it came later, but I’ve always been fascinated by the effects of trauma, and also in how people can sometimes be resilient enough to not be terribly affected by trauma. What makes a person more likely to have a trauma disorder like PTSD or Borderline Personality Disorder? These are questions we’re still answering and I’m sorry to say I don’t have a concise answer at the moment. The best I can do at this point is explain a little about how trauma turns into behaviors that are, perhaps, not the behaviors we would prefer to be doing.
Typically when I explain trauma disorders the first thing I ask is: “How familiar are you with the theory of evolution?” Most people know the basic idea of evolution: That the most well adapted are the ones who survive and pass on their genes. But evolution is a lot broader than just the best adjusted surviving. Evolution also involves a lot of traits that may not be the best adapted for the situation, but are carried across generations because that trait has tagged along with a successful one.
Let’s look at giraffe’s: Thousands of years ago there were giraffes with long necks and short legs, or short necks and long legs. It took some time for long legs and long necks to be the norm for the species. Those other giraffe’s with features that are different from their modern counterparts existed, lived and sometimes thrived alongside their better adapted neighbors. That’s true of human beings today. Certainly there are individuals who are better positioned or adapted to their environments than others, and that’s not a terribly controversial position to take. The interesting thing, to me, isn’t the ones who are perfectly adapted but rather those who tried to adapt to their environment in the ways they knew how and were still were able to survive in their environment despite not being best adapted to it.
So how do we adapt to trauma and how does that present in our behaviors? Basically our behaviors are like microcosms of thousands of years of evolution boiled down into a split-second decision. Imagine that you were that evolving giraffe, but instead of taking thousands of years to grow and change you could just change in an instant how you react to your environment. That’s a closer analogy to how our behaviors change and grow over our lives. Life is long, but it’s often those split-second decisions that we make that have the greatest impact on who we are as individuals.
Now let’s forget about giraffe’s for a minute and talk about people. When people are faced with trauma, and remember, trauma is a subjective experience; what’s traumatic to me may not be traumatic to you and vice versa. In that moment, when you are facing a life event that you are totally unprepared for, or unable to process, our minds go into evolutionary mode: How can we manage this crisis or situation and still survive? So, what happens is, we try out a variety of behaviors in the aftermath of trauma to get our needs met and some of those behaviors are met with what we need, and some aren’t. Often one’s response to trauma can be very intense. I’ll give you an example: One of the hallmark behaviors in PTSD is reckless behavior like risky sex or riding a motorcycle without a helmet. These are just two examples, so if these don’t resonate, there are many other self-destructive things that people with PTSD do like signing up for dangerous jobs or re-enlisting in the military. Why do we do this? Because we tried out lots of other behaviors to have our needs met, and it’s only these “maladaptive” behaviors that are actually hitting the target we’re aiming for. In Borderline Personality Disorder it’s often the more extreme behaviors that get noticed. Think about it like this: You’re a person who has been terribly harmed and what you want and need is affection/attention/healing/love. And so we reach out using the tools that we’re familiar with, but perhaps the conventional behaviors we’ve learned or “evolved into” are not working. They’re not getting us what we want/need.
So, just like in evolution, we try out different types of “adaptations” trying to adjust to our new internal mental environment. We try throwing things, we try screaming, we try begging, we try logic, we try emotion, we try everything we can think of (and some things that our conscious mind would never think of) and the behaviors that are rewarded with attention are the ones that stick. Your mind is smart. It learns quickly that some behaviors get rewarded and some don’t. The thing to remember is this: It’s not always positive attention that gets us what we want/need. Sometimes it can be behaviors that are totally maladaptive to the situation. These behaviors are typically met with negative attention or punishments, but to the traumatized person just reaching out for some kind of connection, even these types of attention can be meeting a need we don’t realize we need met.
I’ll give you an example: Let’s say that once, a long time ago, you were hurt, physically, in an accident. In that moment you found that screaming for help was helpful and got you what you wanted. Now years later there’s a new crisis, and your brain remembers what worked in the past, so you start screaming again. It may be appropriate to the new situation, it may not, but the point is that your brain has adapted to trauma and now this is the way you react to crises now.
I was planning on talking a little about how we treat trauma and change these intrinsic reactions, but this blog has already run a little longer than I planned so I’ll make that the subject of next month’s blog. Thanks for reading. Take good care of yourself and your family.
-Matt