Report on the Childhood Trauma Conference 2016
The second Childhood Trauma Conference took place in Melbourne in early June, 2016. The impressive array of speakers included Dan Hughes, Jonathan Baylin, Allan Schore, Pat Ogden, Vittorio Gallese, Stephen Porges, Ed Tronick, Sue Carter, Judy Atkinson, Dan Siegel and Martin Teicher. For those of you who couldn’t make it, I encourage you to try for the next opportunity, as it was an inspiring and rejuvenating experience. I was richly fed with evocative and emotional storytelling, which gave me goose bumps, and state-of-the-art discoveries in neurobiology that sent shivers throughout my autonomic nervous system. In this preliminary report from the conference, as I reflect on the experience, I offer a sample of the extraordinary neurobiology I learned there, and how I have integrated it with my own work in neuroplasticity research, both as a clinician and as someone who has grown up from (if not entirely out of) a traumatic childhood.
I’ll begin in the middle, with Dan Siegel’s presentation that, with an eagle’s eye, took in the breadth of the neurobiological landscape and convinced me that whether we take a micro or a macro view, integration of information is key for systems to respond meaningfully in coherent and flexible ways. As a molecular biologist, I can confirm that within each cell an integrated subcellular system enables an adaptive and flexible response to stimuli. On a much larger scale, that of brains, which have multiple specialised cell types and distinct regions, integration and connection between these functionally discrete areas allows for inclusion and appraisal of all available, salient data. But why stop there? We have operated under the influence of Descartes for too long, studying the mind and body as if they are separate entities, whereas they are fundamentally interdependent, and intricately, elegantly and adaptively linked. We are whole beings: integration between body and mind, thought and feeling, and our sensing and rational selves is crucial for us to be able to creatively, flexibly, authentically and adaptively respond to our unique circumstances. On his website (http://www.drdansiegel.com/about/interpersonal_neurobiology/), Dan writes: “The absence of integration can lead to rigidity and chaos. . . . The ultimate outcome of integration is harmony.” In his talk, Dan went further still and made a compelling point, arguing that the integration that exists inside of us “within skull and skin” is a reflection of how integrated we are with who and what is around us. Our inside, our connectome (all the connections within our unique brain and between brain and body), reflect our experiences and our connectedness on the outside. From this perspective Dan described developmental trauma as “an impairment of relational integration”.
Experiences of neglect—emotional and social neglect, as well as all forms of maltreatment—will impact on the way we sense our bodies, feel our feelings, and express ourselves. Our unique relational experiences are reflected in our neural pathways, structurally, functionally and adaptively, shaping our brains to best fit the environment and family that we are in. A severely neglected child, with no attachment figure, no regular caregiver, will have their impoverished relational experience reflected in their connectome: they will have fewer connections, fewer synapses, perhaps fewer neurons, and less myelin. A child who is intellectually engaged and stimulated will have a connectome that reflects the same: a wealth of experiences leading to a wealth of connections in regions or pathways in the brain that correspond to intellectual pursuits and engagement. The same child may be emotionally impoverished or receive little physical affection, however, and as experiences of having their emotions and bodies attended to may be scarce, there is likely to be a corresponding dearth of connections within or between brain regions that link body and mind, or that link emotions with soothing relational experiences and reflection.
An implication of Dan Siegel’s point is that the stories that people tell about their experiences are, as many of us already accept, the richest source of information about what they may also need. We have to listen for what we don’t hear as well as what we do. What experiences are missing? What past experiences can be spoken and what cannot be spoken but only remembered by traumatic re-experience or through re-enactment of painful situations and relationships in our present lives? I am reminded of George Santayana’s words: “Those who cannot remember their past are condemned to repeat it”, and Freud’s too: “A thing which has not been understood inevitably reappears; like an unlaid ghost it cannot rest until the mystery has been solved and the spell broken.” Dan’s concept of integration may help us understand what needs to be done with these painful experiences. Perhaps those painful, recreated and repeated experiences are held disconnected—not integrated—in regions of the brain or body where they exert powerful effects, and what is needed are opportunities for integration with other regions of the body and brain. Could these opportunities be new experiences where the shadowy, lost and isolated parts of ourselves and our story are brought into awareness, felt, experienced, understood and spoken, or turned into poetry, art, movement or drama, but come in some way to be known to us and integrated with ourselves and our story? Just as we can reclaim and process these traumas and memories as parts of ourselves and our stories, perhaps in parallel our brains use that same opportunity to build connections from those isolated networks to other brain regions, enhancing our overall sense of integration and coherence.
From a very different perspective, Professor Judy Atkinson seemed to have reached a similar conclusion. In a beautiful and moving talk, for which she received a standing ovation, Judy wove elements of her emotional and personal journey with her creative, innovative and practical professional work. She reminded us that behaviour is a language and symptom is a history; that our bodies hold our memories and bear our unacknowledged burden. When we are not whole and integrated, our pasts, our memories and our pain are carried out of awareness in ways that reveal themselves through our behaviour when we react (or feel as if we have over-reacted) to something or someone in our present. Equally, our symptoms of distress or illness, mental or physical, can tell an unspoken story of our past: where we have had to be strong there is tension; where we have had to numb and distract there is now absence, disconnection and depression; and where we have not been free to be ourselves, there may be issues of controlling ourselves or others. But our behaviour, our symptoms and our bodies can tell us our story if we are open to listening—if we want to listen. Otherwise, those parts of ourselves that are not integrated will make themselves heard in ways that will harm our health, our relationships and our legacy in the world: “Trauma becomes inter-generational unless it is healed.” Dan defined trauma as “an impairment of relational integration” and Judy showed us that trauma fractures our connections with ourselves and with others. To restore connection, to ease traumatised souls, Judy builds circles, “places where people can sit and yarn”. These circles, where we tell our stories and hear the stories of others, connect us and fulfil our need for belonging. Healing and recovery happens in relationships. Judy urged us as healers to place ourselves as close as possible to the pain and suffering of traumatised people in order to take in their revealed truths. We need to “find the stories, tell the stories, feel the feelings and move through the layers of loss and grief”. Dan’s message was that integration is a measure of health; and our integration is a reflection of how integrated we are with the people around us and our environment. Judy’s take-home message, by telling us what integration looks like, was the perfect complement: “To know your story is to know who you are, who you are related to, and the depth of your relatedness.”