FCYU097 cover image See all stories from issue #97, Summer, 2009

Your Brain on Pain: How You Process Trauma
Where emotional pain comes from
John DiLallo, MD

Many people have experienced trauma, which is something so upsetting that the mind cannot make sense of it. Traumas include torture, fighting in a war, rape, and other terrifying experiences. Ongoing abuse, including sexual abuse, is one of the worst traumas because it keeps happening and the abuser is often a trusted adult who should be protecting you and showing you how to take care of yourself.

In a trauma, your body releases lots of chemicals and hormones that help people to survive in a life-or-death situation. You go into “fight or flight” mode, like a small animal fighting off or running away from a predator. When this instinctive reaction happens, it causes the thinking, reasoning parts of your to brain shut down. During a trauma it may be impossible to even speak.

What happens after a person suffers trauma depends on many things, such as how serious the event was and how long it lasted. For a period of time afterwards, most people feel scared, angry, physically sick or tense, or just numb. Many will have bad dreams or memories about the trauma, and many will avoid anything that reminds them about it so that these don’t come back.

For most people these problems get better over time, but some people can suffer these effects for months or years. If a trauma was extremely frightening and was repeated again and again, then the chances are greater that these problems will become an ongoing condition called post-traumatic stress disorder (PTSD).

Finding the Story

image by Sara Goldys

Most researchers agree that trauma affects how your brain turns the things that you experience into memories. If someone asks about something ordinary that you did yesterday or last week, chances are that you will tell them a little story about it, like “On Saturday I went to the store to buy some milk.” Under normal conditions, the brain turns all of the sensations from our experience into memories we can describe in words, usually within a day or two of an event.

But during a trauma, the brain’s process of taking all the sights and sounds and other sensations of our experience and making them into a story comes to a halt. For example, let’s say you had a car accident. Your brain may take in the sounds of screeching tires, the flashing light of sirens, the tightness in your fists, or the smell of smoke.

But because of your intense fear, your brain may not be able to make a word-story out of this experience. You may be left with strong sensation-memories that you can’t describe in words: sights, sounds, and also feelings you had in your body while you felt the terror. These sensation-memories may come back to you whenever something reminds you of the accident, along with the fear or other emotions you had at the time.

You might start avoiding cars or busy intersections just to try to prevent this. Your sensations might come back during nightmares, or even during a flashback, which means feeling like the trauma is really happening again while you are awake.

In therapy, you can learn to handle your trauma sensations and to tell the story of your trauma so that it loses some of its power over you. Over time, you can begin to put it behind you.

Dr. John DiLallo is a child and adolescent psychiatrist with over 10 years’ experience working with children and young adults. He is the director of the Psychotropic Medications Unit at New York City Children’s Services, and he practices clinical psychiatry at the Hallowell Center in Manhattan.