Redefining Trauma: Understanding and Coping with a Cortisoaked Brain

Sarah Wright, Sarah E. Wright

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000078091
• Topic: Biological Sciences
• Subtopic: Mental Health in Psychology
• Index: Biological Sciences

This accessible guide explores how our brains react to stress and offers a fresh perspective on how we define "trauma." Probing how the words we use can influence our understanding of distress, this text focuses on expanding awareness of excess stress and reducing judgment of its potential impact on relationships and day-to-day life.

Helpfully split into three parts, the book introduces the terms "cortisprinkled," "cortisaturated," and "cortisoaked" and provides a rationale for why these states of brain occur. The role of culture and society are highlighted, and an in-depth focus on coping and offering support to others is presented. Whether caused by sexual assault, social rejection, abuse, the taboo of sexuality, disadvantaged status, or other difficulties, chapters detail specific coping skills and step-by-step strategies to deal with a variety of stress responses. Advice is offered on reconnecting with sexuality, phrasing difficult questions, and ways to offer validation, with concrete recommendations on incorporating healthier practices into everyday life.

Both metaphor and real-world vignettes are interwoven throughout, making Redefining Trauma an essential and understandable resource for therapists and their clients, parents and support givers, and anyone looking to develop practical, informed methods for dealing with stress and trauma and reclaim life with intention.

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INTRODUCTION

What Is “Trauma?”

Event vs. Response

Picture yourself at age 16, not as you wish you were at that age, but really try to remember who you were then: What clothes did you wear? How did you style your hair? Who did you spend time with? Now, think about how upsetting it would have been for you to fail a class. Would that have wrecked you? Was that typical in your experience? Maybe it didn’t even matter because you already knew you were committing to the military and grades were irrelevant. What if you had made a baby? Would that have been catastrophic or a moment to be rejoiced? Would it have been a manageable stress? Would the anticipation of family being involved alleviate or add to that stress? Would either of these things have been considered traumatic? If they happened, were they traumatic?

In the DSM 5 (APA, 2013), “trauma” is defined as the experiencing, witnessing, or having knowledge of a loved one enduring a life-threatening event. However, not everyone who goes through something objectively defined as “traumatic” experiences it as such. Many people survive car crashes or active military combat (Yehuda, Southwick, & Giller, 1992) without feeling their ability to cope has been overwhelmed (Szabó, Kelemen, Levy-Gigi, Kéri, 2015). Some actually seek out life-threatening scenarios (e.g. extreme sports) and enjoy the rush of knowing survival is not guaranteed. Research has shown that the majority of people who endure something generally considered “traumatic” don’t display problematic symptoms afterwards (Lukaschek et al., 2013; Lancaster, Melka, & Rodriguez, 2009). Conversely, others who go through difficulties that involve absolutely no threat to life, such as those described in the opening paragraph, have responses that fit the description of a trauma reaction (Lancaster, Melka, Rodriguez, & Bryant, 2014; Anders, Frazier, & Shallcross, 2014; Mol et al., 2005; Scott & Stradling, 1994). So then, what is “trauma?”

The importance of language is substantial. In asking someone if they have been through something “traumatic,” they are likely thinking about threat to life. But what about all the other heinous things that humans endure? What about being a racial minority and routinely fearing mistreatment (or worse) at the hands of others? Or perhaps the daily stress of those who are gender non-conforming and tolerate unrelenting stares from people who are trying to “figure out” what gender they represent? Or the young person who gets told every day that they are a burden to their family and that they hadn’t really been wanted in the first place? Or the spouse who fears being shamed and belittled with any argument? Are these scenarios not likely to take a toll on one’s ability to function, interact, and find happiness?

There is relevance in the stress from daily life. Trauma often gets framed as an all-or-nothing concept; either something was “traumatic” or it wasn’t. However, reality is vastly different. Stress exists on a continuum and the accumulation of daily stress can also impact the brain, especially if this state of stress is persistent over time (Lupien, Juster, Raymond, & Marin, 2018; Chetty et al., 2014; Grimm et al., 2014). For some people, especially those lacking in social support and/or healthy ways to cope, the daily grind may take a very real toll on the brain. That’s not to say that having to work a 40-hour/week job is necessarily “traumatic.” However, it does highlight that the types of changes people experience after facing very intense hardship or threat are not vastly different from those felt to a lesser degree from unrelenting daily stress.

It is difficult to objectively define trauma. Who am I to tell someone that what they went through either was or was not “traumatic” for them? This further emphasizes the importance of the question: What is trauma? It is a challenging concept to standardize, since experiencing something as “traumatic” depends on one’s previous experiences (especially in childhood), expectations, relationship with vulnerability, neurobiology, available support systems, and awareness and application of healthy and effective means of coping.

Power of Words

What comes to mind when you hear the word “trauma?” Are you among those who think of emergency rooms, combat, physical injury, or sexual assault? It isn’t unusual to assume extreme events, especially those that are potentially life threatening, given the diagnosis of post-traumatic stress disorder (PTSD) requires that a risk to life be present, threatened, or witnessed (APA, 2013). These are the connections society (and the mental health field) have ingrained in us.

The word “trauma” is less likely to conjure up examples such as being a racial or sexual minority, enduring significant loss, or working three jobs while trying to parent and still find time to be human. Our brains have not evolved as fast as society and technology, and often struggle to keep up with the many demands and stresses of daily life. Having “trauma-like” reactions to less than life threatening events can be confusing or frustrating for the person experiencing them, and may be easily misunderstood by others. People then face the stigma of dealing with symptoms that may be judged as excessive given they haven’t been through something “traumatic.” Using an extreme word to describe a common phenomenon runs the risk of both minimizing the intense struggles of some and overlooking the real effects of general distress on others.

The word “normal” is another that’s potentially loaded. Many people want to fit in and are desperate to know what defines “normal” to ensure their behaviors or experiences are in line with the rest of society. When something goes awry in life, we tend to have the expectation that things will proceed as they always had, that they will stay “normal.” But what if the revised version of normal is completely different from how things had been previously? What if “normal” changes, yet people aren’t ready to embrace the shift? This is likely to set people up to misunderstand, judge, or even pathologize a reaction that is not only likely but also vital for human survival.

There is an inherent power in the words we utilize. The book Words Can Change Your Brain (Newberg & Waldman, 2013) details this beautifully. Humans have a far richer inner experience than our words can convey, which highlights the importance of choosing from our limited lexicon with intention. How many people are discouraged from fully processing an emotionally and neurobiologically significant situation because it didn’t fit the definition of “trauma?” How many people judge reactions and feelings resulting from an emotionally charged situation because they haven’t heard others talk about a similar reaction, and fear that what they’re experiencing isn’t “normal?” Western culture is working towards legitimizing and validating mental and emotional health, yet in the meantime, the everyday struggle is real. People are taught they should be able to manage things on their own, asking for help is weak, and dealing with distress by suppressing emotions is ideal. We have very little permission to struggle both from ourselves and from others. Friends and family are quick to offer solutions when often what we want is validation and support. Others share their stories of hardship in an effort to ease our suffering without realizing that companionship and understanding are the most readily available and potent means to that end. Further, when people are unable to make sense of their struggles in a way they understand and can express, they are robbed of the opportunity to know how normal they really are. If no one hears what’s happening, no one can offer compassion or empathy. In essence, lack of understanding facilitates isolation and emotional distancing, which then further exacerbates a cultural crisis at hand—we tend to pathologize any emotion other than “happy.”

While escaping life threatening events is serious and can have grave implications for a person’s mental, emotional, and physical health, what about the not so drastic events that can still have catastrophic consequences? What terms do we use to assess, explore, process, or explain? How do we talk about something that leaves us more than just “stressed out” yet didn’t threaten to end our existence? In this book, the case is made for the introduction of a new set of terms into the clinical lexicon: Cortisprinkled, Cortisaturated, and Cortisoaked. Cortisprinkled refers to a brain working as it does on a daily basis—being sprinkled with sufficient cortisol (stress hormone) for adequate functioning and motivation, then returning to a state of balance. Cortisaturated alludes to a brain saturated with cortisol resulting in the activation of more protective responses while still being able to maintain some degree of daily operations. A slower return to baseline from this state is expected. Cortisoaked speaks to a brain so soaked with cortisol (and other stress hormones) that it does not function as it does on a routine basis. This flooding of cortisol essentially puts the brain into emergency management mode, where the primary focus is on survival. Recovery from this state often includes the establishment of a new baseline altogether. These suggested terms are in line with recommendations made by the National Scientific Council on the Developing Child (2005/2014) to divide stress into the three categories of positive stress, tolerable stress, and toxic stress.

While the word “trauma” often conjures up gruesome or graphic images of life-threatening situations, “cortisoaked” ideally calls up an image of an overwhelmed brain functioning in survival mode. The former tends to highlight the importance of the event, while the latter focuses more on the relevance of the neurobiological reaction. This also brings the focus away from what happened and who was at fault, and squarely on how the person/brain is making sense and responding. If the focus is more on the brain and the rationale for its reaction, perhaps healing doesn’t have to feel so scary and daunting.

There is also relevance in framing a response as one point on a continuum. Speaking about “trauma” in a binary (either it was traumatic or it wasn’t) is not only inaccurate, it can be harmful. It can leave people questioning their reaction and lead them towards invalidating experiences that didn’t seem “bad enough” to warrant the resulting reactions. By recognizing the cumulative effects of stress and cortisol and having a way to talk about this, hopefully people will be less inclined to judge a very human and protective function of our brains.

Another benefit of embracing these new terms is the potential for the brain’s response to be seen in a normal context. When we can understand what’s happening in our brain and the intended function of these processes, we are able to be more intentional in the responses we choose which maximizes our ability to learn from the event and facilitate healing. Following an experience of being cortisoaked, many people feel that something is “wrong” with them because of very normal reactions. Things such as jumpiness, difficulty sleeping, and hypervigilance are seen as problematic and intrusive, resulting in efforts to make them go away without first understanding why they’re happening. With education and a name that is less pathologizing, perhaps people would be more comfortable with the brain’s natural reaction to stress, thus removing the layer of judgment from an already difficult situation.

To make any mental health diagnosis, there must be some distress or disruption in functioning present. It would be interesting to measure how many people would no longer fit criteria for mental health conditions if they are able to define and understand their reactions as normal and functional. Would understanding and lack of judgment reduce the distress necessary to qualify a reaction as a “mental illness”?

The ability to predict is one of the main goals of science. Prediction can give people a sense of mastery and control, both of which can be huge for someone dealing with a cortisoaked brain. When reactions are framed as the brain’s normal response to stress or difficulty, people are less likely to see these reactions as a lack of strength, effort, or ability. It’s not that the predicted symptoms occur if someone is weak; they occur based on the degree the brain has been cortisoaked combined with how prepared that brain is to manage this influx of stress hormones. Further, when prediction of symptoms can happen early, it may help to remove the surprise some people experience when they begin to deal with symptoms or notice changes in their daily reality. The term “inoculation effect” is used to describe the phenomenon of anticipating that beliefs will be challenged and preparing to defend them (Banas & Rains, 2010). In this case, preparing for others’ lack of understanding allows more helpful and realistic expectations for moving through difficult events to prevail. It has been found that inoculation is generalizable (Banas & Rains, 2010), meaning that preparing to defend my ideas against one person will help me defend them against another.

Normalizing the effects of stress and cortisol will allow for more specific assessment of the impact various events have on people’s mental and emotional well-being. Once the effects of cortisol are generally understood, people could report on the degree to which they felt their brain was cortisoaked rather than trying to decipher how traumatic an event was. It could also give clinicians a way to understand and normalize the impact of various emotional events that involved neither threat to self nor others.

Learning Through Metaphor

The brain is a fascinating organ and more people are becoming interested in understanding how it works. This growing interest in knowing our brains paired with advances in technology and research capabilities have allowed us to know more about our brains now than we ever have. Despite this, not all research is readily available to the general public, and even less is made available in a manner that can be easily understood and recounted to others. This book will utilize metaphor to present the most recent information in a way that ideally both makes sense and lends itself to understanding, discussion, and application. Some of the same brain areas involved in processing extreme stress are also utilized when interacting with metaphor (Citron, Güsten, Michaelis, & Goldberg, 2016), making it an ideal tool for our purposes. Author Daniel Pink said it beautifully: “if a picture is worth a thousand words, a metaphor is worth a thousand pictures” (Pink, 2006, p. 50).

Metaphor can be a helpful tool when learning a new concept or encountering a novel situation that’s complex or challenging to grasp. Metaphor has been shown to elicit emotion (Citron et al., 2016), and information with an emotional connection tends to be better learned than neutral information (Wiemers, Sauvage, Schoofs, Hamacher-Dang, & Wolf, 2013). Utilizing a familiar concept allows for mental flexibility and thinking about various aspects of that concept. If someone grew up playing a sport, they can likely talk at length about that sport including the rules of play, object of the game, method of measurement or score keeping, etc. Once the known material has been explored and relevant feelings acknowledged, parallels with the new idea can be drawn. Having an existing template makes learning more natural and relatable. The process of applying one set of concepts to another, as is the case in metaphor, increases cognitive flexibility and stimulates parts of the brain responsible for understanding our sense of self (Davey, Breakspear, Pujol, & Harrison, 2017).

Metaphor can also help provide some distance from topics that may be too emotional to address directly without disconnecting completely from feelings. When talking about past issues that are emotionally loaded, especially those that haven’t been processed, we tend to feel the emotion in question, sometimes just as strong as originally experienced. This can make thinking logically a challenge (we’ll talk more about this soon) and staying present long enough for the emotion to subside difficult. Talking instead about something that’s only distantly related allows our both logic and emotion to remain present, creating a more fert...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• CONTENTS
• Author’s Note
• Acknowledgments
• About the Author
• Prologue
• 1 Introduction: What Is “Trauma?”
• PART I What’s Happening in My Brain?: Looks Like Rain Is Coming
• PART II The Significance of Others: Riptides and Lifeguards
• PART III Coping and Healing: Learning to Float and Swim
• References
• Appendix A: Validating Stems
• Appendix B: Q’s Without “You”s!
• Appendix C: Dos and Don’ts of Offering Support
• Index