The Science of PTSD
Looking at the Triune Brain and understanding its role in PTSD
By Mary Tendall, VietNow National PTSD Chairperson
It’s important to realize that even though many people think PTSD is incurable, there are many methods and tools people can use to relieve the symptoms and often make major life improvements. The situation is not hopeless. Help is available.
The key to recovery is learning more about how PTSD actually happens.
The key to recovery is learning more about how PTSD actually happens. Most of us realize that the symptoms of PTSD occur after someone has been through a traumatic experience (such as a war-time experience). These symptoms can show up very soon after the experience, or may take years to develop. Either way, it can help if the person suffering the symptoms understands what’s actually going on inside the brain. In this article I’ll explain how and why PTSD occurs.
PTSD can be explained scientifically, since the mechanics of all the symptoms happen in the brain. And this article will be directed mostly toward military veterans, and will be an over-simplified, but adequate explanation of how and why war-time experiences can cause the brain to reorganize itself in order to serve most efficiently in an unsafe environment – such as combat.
I’ll also explain why the combat-ready programming sticks around after the return from combat or the military environment. I’ll show how thoughts, actions, and feelings often don’t coincide with what is expected or appropriate in civilian life, even years after deployment. We’ll start with the basics:
The Triune Brain: Brain Stem
The first part of the brain to develop is the brain stem (see the illustration above) and the cerebellum, also known as the reptilian brain or the deep brain. In reptiles, this is the part of the brain that dominates. It controls muscles, balance, and automatic functions such as breathing and heartbeat. This part of the brain remains continually active, even while sleeping. It also concerns itself with the “freeze” response when needed for survival. It should also be noted that the deep brain is connected to the central nervous system and the entire spinal cord.
The Triune Brain: Limbic System
The second part of the human brain to develop is the limbic system, also known as the middle brain. All mammals have this function, and its operations include emotions, instincts, feeding, fighting, fleeing, and sexual behavior. The limbic system includes the hypothalamus, the hippocampus, and the amygdala. This can be a tricky part of the brain, because it remembers charged, unresolved experiences, and even years later the amygdala will signal the body and mind what to do, based on past charged experiences. If triggered, the amygdala sends messages to both the neocortex and the brain stem. It might “tell” you how to think and feel about something, based on stored memories. It filters sensory input, and decides whether a situation is an “all clear” or if “action” is needed.
The Triune Brain: Neocortex
The last part of the brain to develop is the neocortex, which is five times larger than the first two parts combined. It is known as the superior brain, and it includes higher-level thinking, especially in humans. The cognitive functions that distinguish us from other mammals are found in this part of the brain. It is divided into two hemispheres known as the right and left brain. The left hemisphere controls the right side of the body, and is known to be linear, rational, and verbal. The right hemisphere controls the left side of the body, and is known to be more creative, spatial, and artistic.
This article is a guide to understanding what happens in the brain when a person is exposed to unresolved trauma. I will often refer to a combat soldier, in order to more easily illustrate this point, but that does not in any way rule out all other military veterans and their family members who have experienced trauma.
Basic training or boot camp
Necessary training for every soldier must prepare the soldier to survive. Basically that means to train for extra vigilance – constant awareness of location, how to behave, the next mission, how to handle weapons, etc. This added vigilance must become automatic in order for the soldier to survive. This training brings the brainstem into heightened survival awareness.
Necessary training for every soldier must prepare the soldier to survive. Basically that means to train for extra vigilance
During early military training a soldier must learn to numb emotions in order to stay focused. This occurs in the limbic system. Emotions can interfere with a mission, and must be set aside – numbed out and stored away. For example: Thinking of a girlfriend or the loss of a pet could cause major problems while completing a task or mission.
Also, the soldier must be trained into black-and-white thinking. The fact that there is very little gray area in military thinking results in clarity and operational excellence. Higher training is a function of the neocortex.
Let’s look at what happens when a soldier is deployed to a combat zone: All that initial training is programmed into the triune brain
Let’s look at what happens when a soldier is deployed to a combat zone: All that initial training is programmed into the triune brain. With the constant and sustained vigilance in the combat zone, early training now becomes an automatic function of the triune brain. It is continually operating in survival mode.This is an absolute necessity for a soldier to survive, to keep others safe, and to complete every mission as best as possible.
Every combat soldier has a unique experience that is unlike anything experienced before, and there is really no preparation for the intense changes of perceptions that occur while participating in combat. It is also interesting that those who never see actual combat in a combat zone are still experiencing sustained vigilance, and because of the lack of guaranteed safety in that zone, the need for sustained vigilance is often enough for a soldier to eventually suffer symptoms of PTSD.
Upon returning home, the soldier’s brain is still in combat mode – it doesn’t switch back to “normal” automatically or right away.
Upon returning home, the soldier’s brain is still in combat mode – it doesn’t switch back to “normal” automatically or right away. Because the brain is now programmed for survival, its operations trump its previous way of operating during civilian life. Sensory input that in any way represents combat can trigger the entire central nervous system. For instance, the smell of diesel exhaust might trigger a response throughout the mind and body, and cause altered thoughts and feelings, as well as perceptions about the current environment. That’s the “reactivity switch” mentioned in my article “The Reactivity Switch” in the Summer 2016 issue of this magazine – and that “switch” flips in an instant. The very system programmed to create an effective soldier and to keep that soldier alive, now interferes with adjustment to civilian life.
In fact, hypervigilance, numbed emotions, and black-and-white thinking are all included in the definition of PTSD. Enclosed spaces feel unsafe, as does feeling close with loved ones. The system is not geared for civilian life. As one veteran said, “It’s like asking a race car to drive 20 miles per hour when it is prepared for speed and action!” It also explains why so many returning soldiers long to be back in the combat zone, where they felt geared for action, and felt the camaraderie of their fellow soldiers. Confusion displayed by family members, along with the soldier’s own confusion, continues to cause feelings of alienation for the soldier. There’s no place to fit in.
I recently spoke with a veteran who said that his family seemed like strangers when he returned home from Vietnam.
Treatment can bring about improvement
I recently spoke with a veteran who said that his family seemed like strangers when he returned home from Vietnam. He remembers that he didn’t do well in relationships with women, because it actually hurt when they showed love to him. His limbic system was still preventing him from opening up to loving emotions, even as he longed for connection. He said that after he arrived home, he numbed himself out with alcohol, although he has been able to curb that somewhat now that he’s retired.
When he was younger he became a workaholic, but now with retirement, his symptoms have started to interfere with his daily living. He was happy to find out that’s not too late for his symptoms to heal. PTSD is treatable – and my next article will talk about effective treatment.
Smells, sounds, thoughts, dreams, touch, and sights can open up old neural pathways that can alter thoughts, feelings, and actions. All unresolved experiences get stored in a part of the limbic system known as the hippocampus. That storage becomes one big soup that can tell the amygdala to rev up the survival juices when activated. This isn’t voluntary, but once the veteran becomes aware of what’s happening, it’s possible to use methods such as deep breathing, walking, yoga, biking, and other learned methods that can calm down the reactivity. As you may know, the reactivity is physical as much as emotional or mental. It all works together.
There’s a reason why you can become furious over losing something. There’s a reason why you can have homicidal fantasies when someone cuts you off on the road. There’s a reason why emotional intimacy is a challenge. And there’s a reason why you feel that you have to sit facing the exit in a public place.
The main thing to remember is that PTSD is treatable. There are many effective treatments to choose from. Some will actually reprogram the brain back to civilian mode, without eliminating necessary (not intrusive) vigilance. It’s never too late.
You are invited to contact Mary Tendall with comments and/or questions regarding PTSD. Her e-mail address is firstname.lastname@example.org.
*The names of any veterans and/or family members mentioned in this article have been changed for privacy reasons.
Mary Tendall, MA, LMFT, serves as the VietNow National PTSD Chairperson. She has worked for over 20 years with combat veterans and their families, specializing in PTSD. She also works with groups such as Soldier’s Heart, Train Down, and America’s Heroes.