Wednesday, September 28, 2005

Stuck In A Moment

I was unconscious, half asleep
The water is warm until you discover how deep.
I wasn’t jumping; for me it was a fall.
It’s a long way down to nothing at all.

~ “Stuck In A Moment,” by U-2

Abortion and Trauma Reenactment

According to the Elliott Institute, women with a prior abortion experience are four times more likely to choose to abort when pregnant again than are those who have never aborted. Approximately 45% of all abortions are now repeat abortions – nearly one in two young girls and women who come out the back door of the abortion clinic will be going back in the front door one or more times. In Forbidden Grief: The Unspoken Pain of Abortion (see link at sidebar), Dr. Theresa Burke describes the psychological and social reasons why women so often find themselves seeking abortion after abortion. In some cases, it is self-punishment and abuse stemming from the self-hatred the first abortion caused. Also, many women become pregnant again soon after aborting. So those factors that led to the first abortion are still present in their lives, such as poverty and a lack of social support to aid in choosing birth.

There is yet another reason proposed for repeated abortions: the trauma reenactment cycle associated with post-traumatic stress disorder, which Dr. Burke describes as “the adrenaline fix.” We’ve all heard about adrenaline junkies, thrill-seekers who engage in dangerous activities for the “high.” This “high” is a natural part of the fight/flight/freeze response, and is produced by endorphins such as oxytocin and vasopressin. Oxytocin has opiate-like qualities, and has a calming psychological effect. When it acts in certain areas of the brain, it “rewards” that brain activity. Because it is like an opiate, the reward is powerful.

We’ve discussed oxytocin before, in the segment regarding abortion and maternal bonding. Oxytocin is a neuropeptide, a hormone unique to mammals. It is made in the brain, and is distributed differentially in regions of the nervous system, but particularly in the hypothalamus and in those areas of the brain that regulate the autonomic nervous system. It has been associated with birth, lactation, sexual behavior, pregnancy, and social bonds, like the maternal bond. Because it is uniquely mammalian, it is thought to be of particular help in overcoming the pain and anxiety surrounding birth and the post-partum period. Oxytocin is produced in higher levels during pregnancy. Perhaps this is the glow of a happy mother-to-be?

Oxytocin is released when we meet the tiger on the jungle path, and it is “taken up,” or used by those areas of the brain that come into play when we are faced with a life-threatening situation, such as the amygdala, which we’ve discussed before as that area of the brain responsible for processing the emotional responses associated with sensory experiences during times of acute stress. It is also released in response to pain because it has endorphinergic, or pain-killing, properties.

During labor and birth, oxytocin would normally be taken up and used by the anterior cingulate of the brain, that area in which we form social bonds, like the maternal bond, and where we determine our sense of self, or identity. Under other circumstances involving pain and anxiety, like meeting a tiger in the jungle, the amygdala would be using the oxytocin, or getting rewarded for learning from the fear and anxiety surrounding the events that are causing us pain, so we will learn permanently and with an opiate-like reward to avoid those situations again. But it is contra-indicated for a species to be afraid to reproduce – it will not survive that way. So in the normal birth process, the anterior cingulate, a “higher” brain region, takes up the oxytocin instead. This disables the amygdala in a way, which lessens the traumatic impact of birth. And the anterior cingulate is rewarded with an opiate-like high to stimulate the mother to bond with her child. Further, mother’s oxytocin sends a chemical signal to the unborn infant’s nervous system, which then produces its own oxytocin and mirrors the effect in the infant’s brain. Thus, the infant bonds with his mother and “forgets” the trauma of birth. A similar pattern is seen in paternal behavior, but the research into the chemical aspects of social bonding is slim.

But we’ve already seen that the anterior cingulate does not activate properly in people who have post-traumatic stress disorder. In The Body Bears the Burden: Trauma, Dissociation, and Disease, Dr. Robert Scaer describes how this may be why those who suffer from post-traumatic stress syndrome experience symptoms such as isolation and social anxiety, since the anterior cingulate is the area responsible for social behaviors and our sense of self (Scaer, p. 110). It also puts the brakes on the amygdala, in some cases perhaps by taking up its oxytocin. Without the anterior cingulate’s gating function, the amygdala is rewarded with an opiate-like substance for its activities – evaluating sensory input for emotional meaning; facilitating the state of arousal (fight/flight/freeze response); and fear conditioning (learning). Dr. Scaer describes it this way:

“Endorphin-based reward systems have evolved as a means of facilitating behavior that is specific to survival, not as a means of perpetuating reenactment. If the neurochemical changes of traumatic stress have resulted from dissociation and a truncated freeze response, however, the result may be endorphinergic reward for reenactment rather than survival,” (Scaer, p. 95).

An author once wrote, “Destiny struggles to assert the pattern that was meant to be.” In the case of the traumatized aborted woman, perhaps it is her body that is struggling to assert the pattern that was meant to be. When we end a woman’s pregnancy, we terminate the need for the anterior cingulate to use this oxytocin for maternal bonding, and the newly-developing sense of self as "Mother." When we end a woman’s pregnancy with purposeful violence, traumatizing her, that oxytocin supply will be taken up by the amygdala in her brain, and she will learn to associate the pregnant condition with fear. And in a struggle driven by deeply rewarding, psychologically calming oxytocin, she will unconsciously struggle to assert the pattern that was meant to be by becoming pregnant again, and by aborting that pregnancy, too. She may also engage in other risk-taking behaviors out of the same need for the oxytocin fix, such as self-mutilation; starvation (anorexia); promiscuity (note that oxytocin is also related to sexual behavior); or she may seek to replace it with other substances, like drugs and alcohol.

Dr. Scaer warns us against judging these people too harshly for their behavior. At this point, it has become something against which an individual cannot struggle alone. In his words, “…the phenomenon of trauma reenactment is rooted in unconscious biochemical systems of the brain, and is probably a neurophysiologically deep-seated conditioned response,” (Scaer, p. 87). But what can be done to break the cycle? It would seem that here is where the success of group therapy in treating post-traumatic stress disorder comes in to play. When we bring our traumatic memories to life with others who share the experience, we bond with them. When we make social bonds, the anterior cingulate of the brain is exercised, and the functions of the amygdala are gated. Oxytocin and its cousins are picked up by the anterior cingulate instead of the amygdala, and we are deeply rewarded for social bonding behavior instead of the traumatic stress response.

Actor Christopher Reeve had regained a small amount of movement in one finger as a result of his intensive physical therapy. As I heard it described, his therapy involved working his limbs as if they could feel in an effort to stimulate his nervous system to rebuild damaged pathways. That little bit of movement was said to be proof that it is possible to do this. As it applies to therapy in patients with post-traumatic stress disorder, then, perhaps healing can be found in exercising those areas of the brain that need to supplant the stress response. As we bond with others who have experienced the same kind of trauma, we can rebuild the adaptive neurological response.