Dissociation as a clinical psychiatric condition has been defined primarily in terms of the fragmentation and splitting of the mind, and perception of the self and the body. Its clinical manifestations include altered perceptions and behavior, including derealization, depersonalization, distortions of perception of time, space, and body, and conversion hysteria. Using examples of animal models, and the clinical features of the whiplash syndrome, we have developed a model of dissociation linked to the phenomenon of freeze/immobility. Also employing current concepts of the psychobiology of posttraumatic stress disorder (PTSD), we propose a model of PTSD linked to cyclical autonomic dysfunction, triggered and maintained by the laboratory model of kindling, and perpetuated by increasingly profound dorsal vagal tone and endorphinergic reward systems. These physiologic events in turn contribute to the clinical state of dissociation. The resulting autonomic dysregulation is presented as the substrate for a diverse group of chronic diseases of unknown origin such as IBS, chronic fatigue syndrome and other autoimmune disorders.
The brain and the body are parts of a common interactive system. Any outside stimulus or input to the brain must first be registered by the sensory organ systems of the body, and the brain relies on the body to provide all information having to do with function in general, not just survival. What’s happening in the body continuously changes the brain. The flip side of this relationship is that the brain, in response, also directs and changes the body. Learning of a motor skill by the brain is dependent on the body’s ability to adapt and respond to feedback messages from the brain that direct the somatic musculature. The muscles of the viscera—the organs of the chest and abdomen—also operate through messages from the autonomic nervous system that are generated by the brain, while the sensory messages from these visceral organs inform the brain about one’s emotional well-being. The relative health of the brain depends on the health of the body, and vice versa. If trauma has adversely affected either one, you’ve got to find a means of healing that incorporates both brain and body. You can’t fix one without fixing the other.
We’ve seen how stress and trauma place their own unique imprint on brain function. The spectrum of negative life experiences directly affects how the brain functions, and in some cases actually produces negative physical changes, such as the loss of neurons in the hippocampus through the effects of cortisol, the stress hormone. Stress and trauma can “damage” the brain. It should come as no surprise, then, that abnormal ways that the brain functions in stress and trauma might also “damage” the body. This particular concept has been around for quite a while in the medical field, giving rise to what we now call mind-body medicine, complementary medicine, and in some cases, alternative medicine. The therapeutic approaches employed by this field of practice often incorporate techniques derived from the practice of medicine in the Far East. Examples include meditation, acupuncture, herbs, massage, Qigong, and tai chi, as well as ayurvedic medicine and yoga from India. Most of these practices seek to balance the mind, body, and spirit as a means of preventing and healing disease. This concept certainly has appeal if the primary negative effects on the body in stress and trauma are at least in part due to a disruption in homeostasis, which intrinsically implies a disruption of balance and regulation of brain and body.
There’s a dilemma that Western medicine seems to have in dealing with diseases related to brain function, especially alterations in homeostasis. Allopathic, or Western, medicine depends to a significant degree on measurements of the body’s chemical/physiological state at a fixed point in time. X rays, scans, microscopic images, blood tests, and so on represent a picture of the body frozen in the moment of the test. One can monitor a person’s heart rate, blood pressure, blood-oxygen level, and brain waves for a longer period of time, but this is costly and only gives a brief picture of what we might call the state of homeostasis. Homeostatic disruption almost by definition is associated with emotional disruption and distress. This emotional component often leads the allopathic physician to designate the medical syndromes of trauma as “psychosomatic” diseases, with an emotional and not a physical cause. I think a more accurate term would be “neurosomatic” diseases, as these disorders are related to abnormalities in the balanced function of the brain and autonomic nervous system. Although the abnormal body states in trauma are hard to pin down with tests, they still are quite real and definitely are “physical.” And this dilemma of a changing, unstable state of abnormal physiology and its symptoms is primarily what we’ll be dealing with in considering the body in stress and trauma.
In this article, I’ll review in detail the effect of cortisol on many of the body’s systems, a syndrome Hans Selye called the “general adaptation syndrome,” or GAS. The GAS primarily describes what have been called the diseases of stress. We’ll also be dealing with a number of diseases and medical syndromes that are prevalent in victims of life trauma but depart from the illness of the GAS. The medical syndromes that I relate specifically to trauma reflect the alterations in brain function that occur in trauma. These include “false” body-based procedural memories, persistence of dissociative freeze states, and neurosensitization, or kindling. Obviously many of these syndromes of trauma represent disorders of regulation of the autonomic nervous system, and therefore involve the visceral organs. I’ll also be exploring syndromes and diseases that reflect the frozen somatic procedural memory that characterizes the brain in trauma. This produces not only stuck emotions but also body states reflecting how the brain/body tried to protect itself in trauma. These body states are now frozen as “false” implicit memories—false because they represent memories for an event in the past that is perceived as still being in the present. Many posttraumatic body disorders reflect the kindled, sensitized nature of the brain, leading predictably to syndromes of hypersensitivity to many sensory stimuli. These sensitization disorders, which are called syndromes of kindling, may involve one or more of the body senses. And many trauma syndromes reflect the process of dissociation, or cutting off from awareness, of regions and parts of the somatosensory body that tried but failed to protect the trauma victim.
Cortisol and the Diseases of Stress: The Price of Adaptation
Stress basically demands that the brain and body adapt to a stressor—an event or experience that disrupts homeostasis but is not sufficient to trigger the full-blown fight/flight response. There’s an element of arousal in this process, though not as extreme as that in the fight/flight response, and the amygdala is mildly activated when the brain senses messages that imply even a subtle threat. There is a continuum between stress and trauma that is mainly defined by the degree of helplessness the person is experiencing. In fact, the escalation of a stressor to actually being a life threat is entirely possible. But if the stressor continues without ever becoming a life threat, the brain takes a different pathway than it does in trauma to adapt. This pathway is basically the same as the sympathetic nervous systems relationship to the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is the origin of the hormonal response by the body’s endocrine system to prepare the body to adapt to a stressor as long as it persists. The end result is the release of cortisol from the adrenal cortex, or outer layer of the adrenal gland.
Cortisol damages the neurons of the hippocampus and can contribute to memory and cognitive problems in trauma victims. In large amounts, it may also affect the cerebral cortex, producing arousal, vigilance, delusions, anxiety, rage, and even psychosis. As long as the stressor remains present, cortisol will remain elevated in order to help the body deal with the ongoing, low-grade threat. This state of threat will result in the gradual development of the GAS. Helping us maintain vigilance in the face of low-grade threat, the GAS state of autonomic tuning promotes the ability of our heart and circulatory system to deal with increased physical demands and our level of blood glucose to meet the increased caloric energy demands of the body and especially the brain. In the relatively short term, it promotes survival, but in the longer term it literally causes a breakdown of the body.
Cortisol also acts as a modulator of the immune system. In high amounts, it suppresses the immune system. In the early days of organ transplantation, chemicals related to cortisol were used to suppress the immune system to prevent organ rejection. Cortisol-related drugs have also been used in autoimmune diseases, such as rheumatoid arthritis, lupus, and multiple sclerosis. Autoimmune diseases are inflammatory in nature, and cortisol also suppresses inflammation. But improvement in the autoimmune diseases with cortisol is associated with the destructive effects of the GAS. Suppression of the immune system unfortunately also makes the person more prone to what are called “opportunistic” infections by bacteria and viruses that aren’t normally very infectious. If taken for a lengthy period of time, cortisol also can contribute to the development of unusual forms of cancer that are generally held in check by the immune system. In many ways, prolonged exposure to cortisol leaves the person subject to many of the tumors and infections seen in the immune deficiency caused by the AIDS virus. As a result, during prolonged stress, persons are vulnerable to the development of viral diseases. That’s why cold sores are common under stress.
Cortisol also causes the kidneys to reduce their excretion of salt in the urine. Retaining salt causes blood volume to increase, an important piece of survival insurance in case the threat becomes physical and the person experiences injuries causing a loss of blood. Increased blood volume also guarantees the brain’s access to circulation. Both of these effects are adaptive measures for dealing with stress in the short term. Cortisol also raises blood pressure, during both exertion and rest, and increases baseline pulse rate, both of which ensure maximal blood flow to the brain. It causes a significant increase in blood glucose levels. The brain counts solely on glucose as a source of energy. Increased vigilance, glucose, blood pressure, pulse, and blood volume help provide support for blood circulation and optimal oxygen and nutrients for brain function—in the short term.
But cortisol also causes an increase in serum cholesterol and other lipids. It causes an increase in secretion of stomach acid. You are probably beginning to see the price exerted by the adaptive GAS. Elevated blood pressure may contribute to sustained hypertension and stroke. Sustained elevated blood sugar may trigger clinical diabetes. Elevated blood lipids may lead to atherosclerosis and coronary artery disease. Immune suppression may lead to opportunistic infections and conceivably cancer. Elevated stomach-acid secretion may lead to peptic ulcers. Increased vigilance can lead to mental disorders, especially mania and psychosis.
Finally, cortisol in the long run is catabolic—it breaks down and changes tissues. It causes wasting of muscles, increased fat deposition about the abdomen, osteoporosis, swelling of the face, and the masculine effects of acne and increased facial hair growth in both genders. Many of these conditions have been called “the diseases of stress. Recovery must include focus on body and mind, striving for feelings of safety and stress relief. Explore this with a trauma specialist.