FCYU-Feature Story

Your Brain on Pain
You can heal from past trauma and loss

By John DiLallo, MD

Changing Your Brain

Researchers who study the brain have begun looking at how much we are shaped by our relationships with other people. Starting when we’re small, our brains are formed in part by our attachments to the people who take care of us. Whenever an adult picks up a crying child and holds and talks to him, the child begins to learn how to take care of his emotions in stressful situations.

Over time this learning causes connections to happen in certain parts of the child’s brain. Those brain connections are the ones that will, in the future, allow the child to understand her own emotions, to handle stress, and to feel caring toward other people.

If you didn’t have stable or consistent adults looking out for you as a child then your brain may not have learned as much about how to handle your feelings when bad things happen. The parts of the brain that allow this may not be fully developed yet—like muscles that have not been used enough to grow strong. Sometimes this can make it harder to control negative feelings like anger, sadness, fear, or just general stress.

So part of what brain research shows is how important it is to learn to have trusting relationships with people who help us feel safe. And it is just as important to learn skills to take care of our difficult feelings, especially if the people who raised us didn’t show us how.
If negative feelings stay strong enough for a long time, it’s more likely that a person will develop a more serious problem like depression, bipolar disorder, or panic disorder. Most people who get to this point need psychotherapy or medication to help them start to feel better.

The good news for young people in foster care is that you can “teach” your brain the emotional awareness and management skills that you might not have learned when you were younger. Once you learn those skills and develop healthier relationships, your chances of having mental health issues get much lower.

Where Emotional Pain Comes From

Many people in foster care have suffered worse things than an indifferent parent. Many 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

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.

Changing Your Life

For people who have suffered from trauma, abuse, or neglect, there’s good news. When you work on your issues, your brain can make new connections that help you to manage painful emotions. Safe and trusting relationships with therapists and other caring adults can help with this. Likewise, anyone who is having problems with mood swings, fear, or dangerous behaviors like substance abuse can learn ways to take better care of themselves—even if you have never been taught how to do this before.

Trusting relationships with people who care about us help increase our ability to manage our stress and negative feelings—including the terror of trauma. Often as you’re learning to control your response to negative emotions, your relationships will rapidly improve, so there can be a positive spiral effect. Medications sometimes help you work through the painful feelings that might have seemed too big to control otherwise, and many times people can come off medications after a period of emotional work.

Helpful Therapies

There are several ways that psychotherapists can help with pain from your past. Some therapies like CBT (Cognitive-Behavioral Therapy) help you look at thoughts you have over and over about your trauma and how these might be hurting you. For example, most kids feel like it is their fault when something bad happens, and they may continue to believe this even when they are old enough to understand things differently. CBT can help you look at that self-blaming and remind yourself that it’s not your fault.

Other therapies focus on the emotional and physical sensations that you feel when you think about your trauma. These approaches can increase your self-awareness and sense of control, until you begin to experience your emotions as parts of your life that you can manage instead of uncontrollable events that ruin your life. Some therapists also recommend activities that help your brain stay focused on the present—like yoga, meditation, or martial arts. These can help your mind and body understand that your dangerous experience is now over and that you are now safe.

More and more, scientists realize that the brain keeps changing throughout our lives. The parts that got stalled or hurt can come back to life.

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.

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