The effect of trauma on the brain and how it affects be… — Transcript

I want to ask you to think back to some occasion in your life when you may have gotten in an argument with someone.

Particularly someone that you love, you cared for a lot, a family member, a spouse, a parent.

And really reacted, really reacted, got so angry, did things, you said things, maybe broke stuff, said hurtful things, and then later on reflected on your behavior and wondering, what happened? Where did that come from?

I want to look at some of the factors that contribute to that type of overreaction, that mechanism, that hyperarousal that occurs.

Hyperarousal, anger, hostility, where does that come from, what generates it?

I'm going to talk about stress, okay, stress as a as a factor that can influence behaviors, and look at the anatomy of the human brain.

It actually, we actually have two brains that are contributing to our behaviors, two brains contributing to our behaviors.

And stress is particularly influential on one of them, stress is nothing that we think about, right, we don't come up with stress, it is a reaction to the external environment.

So let me talk about the two brains, I have a diagram here of this the cortex of the brain and this structure underneath the cortex of the brain, which is labeled brainstem in here, but I'm really talking to talk about the subcortical brain, this entire structure here.

The cortex of the brain is what I'm going to call the human brain, the intelligent brain, it's where our personality is, our our individuality, where we make choices of our mate, what we eat, what kind of music we listen to, what car we drive, where we live, what type of life we live, we take in sensory information and it's processed in the cortex and we take actions based on sensory information.

That's where our personality, our individuality, is all centered in that cortical area, note in the human brain, it's actually the the by far the largest mass of the human brain is cortex, okay?

We rule the world as humans, why, not because we perform animal functions better than any animals, we're not bigger, faster, stronger than animals, we think better, we have the largest cortex and we rule the world.

But we're animals, we eat, make waste products and make babies, and that behavior triggered by our primitive animal brain is sometimes responsible for triggering some of the behaviors that we're not particularly fond of.

So this primitive animal brain, what does it do, well, the brain reacts to situations whether we want it to or not, particularly this animal brain, which doesn't think, it just reacts to the environment.

So if I, if I said to you, hey, let's all go outside and race across Broad Street, but don't let your heart beat increase, could you do it? No.

You can think to yourself, hey, I'm going to stop my heartbeat for 10 seconds, but you can't do it.

The thought exists, the thinking exists in the cortex, the human brain, but the animal brain is controlling your heartbeat and won't let you do it, so you can think all you want about lowering your blood pressure and it won't happen, that primitive animal brain is maintaining your heartbeat, your breathing, your digestion from the moment that you're born.

And even, I mean, even pre pre-birth, you know, as a fetus, that these structures start operating in that central nervous system, primitive animal brain is operating nonstop until it until your death, pretty amazing, okay?

I'm going to ask you to look at another way that that this primitive animal brain reacts to situations, okay, so this, you know, let's let's picture a bunch of guys hanging out, arguing about who's going to win the Super Bowl on Sunday, talking about cars, whatever, whatever men might want to talk about when they're involved in a conversation, I'm a man, so I look at, you know, I only have a male perspective on things, but a bunch of guys are sitting around talking.

And all of a sudden, during that conversation, this really attractive looking woman walks by with an inappropriately short mini skirt and an inappropriately tight t-shirt, what's going to happen to that conversation?

All right, the little snickers in the audience, no, not me, man, I don't look, you know, men will be attracted to that, not because they're out there searching for mates, married men might react that way, okay, but because of the fact there's an animal instinct of sexual attraction.

Why do advertisers put sexually attractive women in ads to attract attention to that ad, so people go and buy stuff they don't need, okay, it's an animal instinct.

Now, I may be distracted at times, but I'm married, so I don't go out and chase the girl, you know, married men, committed men in relationships might be attracted, might be, uh, there might be like a magnetic, boom, but back focus on, hey, I'm married, yeah, I think the Patriots are going to lose, or whatever, you know, whatever the conversation is, you know.

But the reaction, and I don't know how women react to men, I mean, you know, fortunately, you you do react to us ugly guys, but, uh, that's good, you know, but that primitive sexual instinct is a really important behavioral driver of on a day-to-day basis, you know, male elephants are attracted to female elephants, female frogs mate with male frogs, all species mate, sexual attraction, basic animal instinct.

A more powerful animal instinct programmed in that primitive animal brain is survival, and how do animals survive, fight or flight.

Okay, much more powerful instinct, so the primitive animal brain to review, runs our body, breathing, digestion, uh, heartbeat, blood maintains blood pressure, and it's programmed for primitive animal instincts that all animals have, eating, sexual attraction, seeking safety and shelter, and then that most powerful instinct, survival, fight or flight.

The cortex of the brain is our thinking brain, it makes decisions, it takes actions, it does things, okay, based on sensory information, it thinks, that's where our memory is located, all of our processing.

Now, my my job on a daily basis is I work, I'm a physician, I work, I'm the director of the traumatic brain injury for the uh, military down here at Fort Gordon, Eisenhower Army Medical Center, and I'm going to use some examples of what happens to soldiers when they're taken from the United States, sent over to Iraq and Afghanistan, and experience the traumatic experience of war.

And how does that experience impact their performance, how does that experience impact their behaviors based on the influence that that traumatic experience has on their brain, whether they want it to or not, okay?

So, what they do is they go to a place like Iraq or Afghanistan, and what is the enemy trying to do to them when they're there? Kill them, try to the enemy's trying to kill these men and women, so their fight or flight, their primitive animal instinct is ramped up and magnified, turned on big time, all the time, not for like 20 minutes here and 10 minutes here, but nonstop for 24 24/7 through their entire time of deployment, I met I was I was with a patient this morning, seven deployments, seven deployments, 14 months minimum of those seven in those seven deployments.

Hyperactivated fight or flight, and when you're in a place where, you know, bad guys are trying to kill you, having your fight or flight activated to respond real quickly is the best thing that could happen to you, and it functions great when you're in a combat zone.

But now let's take that soldier and return him to the United States, you get on a plane, come back to the US, get off the plane, ah, I'm back home, what part of the brain is recognizing the geographic shift back to the United States, the cortex, the intelligent human thinking brain.

But where was this hyperaroused fight or flight located, in the primitive animal brain, the subcortical brain, specifically a structure called the amygdala, which becomes hyperactivated and triggers fight or flight.

Now, that was very, very powerful and essential in a combat zone, but the soldier now comes home, and he's still hyperactivated, so to give you an example, I had one of my men went to a, he was home for a few months, he was feeling pretty good, he went to a rock and roll show in Atlanta, hanging out in Atlanta, the concert, was doing okay with the crowds, but all of a sudden, boom, fireworks go off, bam, he he dives to the ground.

Now, he didn't hear the explosion and go, hmm, that sounds like a bomb, I'd better duck, okay, he reacted, non-thinking, so now let's look at the anatomy of the brain, because there's one more super important point to make in here that's fascinating.

Sensory information comes into, you know, we see, hear, taste, touch, and smell, that sensory information comes into our sense organs, it's sent to a structure in the brain, except for smell, which bypasses the thalamus, but all the rest are sent to the thalamus, which is a relay station and it sends the signal to both the human intelligent cortical brain and the primitive animal brain.

So, in this case of this explosion at a rock show, the explosion gets to the cortex and the cortex is going to think about it, hmm, explosion sounds like a bomb, but wait a minute, I'm in Atlanta, oh my God, it's a terrorist bomb, but wait, the band's still playing, nobody's running for cover, nobody's hurt, oh man, it's fireworks, whoo, I'm okay, and the cortex could figure that out very quickly, simultaneously that signal went to the animal brain, the animal brain doesn't understand geography, it's hyperactivated, it's hyperactivated particularly to explosions, which in war meant what, IEDs, rocket propelled grenades, mortars, blood, guts, death, body parts.

Here's the second key point about this primitive animal brain, number one, it doesn't understand geography, number two, it's faster than the thinking brain, the animal brain actually is physiologically wired to respond faster than the thinking brain.

So before the soldier can think that soldier was fireworks, that that explosion was fireworks, boom, he's on the ground diving for cover, you know, by the time he hits the ground, he's going, oh my God, I feel like a jerk down here, you know, because everybody else is up cheering and he's on the ground, okay, but it was a non-thinking response, you know, non-thinking response triggered by the animal brain, which is wired to respond faster, and when you think about it from a survival perspective, a survival perspective, the faster we react, the more likely you are to survive.

So indeed, through an evolutionary period, you know, the human species has been around about 300,000 years, but for 300 million years, we have had, animals have had a fight or flight reaction, I don't know who figures this stuff out, but that's what it says in the biological books, so.

300 million years of of fight or flight, you know, the faster they react, the more likely they are to survive, the animal brain's not very smart, it's fast, it's fast, the more the quicker you respond to dangerous threatening situations, the more likely you are to survive, okay?

A child that grows up in an abusive environment, you could take them out of that home, right, and put them somewhere else, but if he's experienced, he or she has experienced significant abuse in that home, that abuse has impacted their arousal system, their primitive animal brain, no matter how much in their cortical brain they may want to overcome that, they are still reacting to situations programmed in that primitive animal brain, which you can't change by thinking.

Anymore than you can change your heartbeat, your blood pressure, okay, eat and hold your food in your belly for four hours before you digest it, right?

So let me talk a little bit about irritability, okay, so there was a man and wife who were at home, and the wife asked her husband, honey, can you take out the trash for me, sure, baby, no problem, I'll take out the garbage.

So the man, he gets up, took out the garbage, he did a good job, cleaned up everything nice, came back in the house, sat down, job done.

Now, meanwhile, his wife walked off into another room, and they had two little children, the two little children had spilled chocolate milk all over this beautiful brand new white sofa, she was angry now, she's got this new sofa with big nasty stains on it, she's not happy, okay?

Why did they let these kids drink chocolate milk in here, why did I get a white sofa, my relatives are coming to visit and I got this nasty stain on here, boy, is she angry, she's not mad at her husband, okay?

But she comes back to her husband with a mean angry look on her face, okay, and now her husband's in a maybe fatigued, stressed out with, you know, stuff going on at work, or whatever, he's, you know, not particularly in a great mood, she comes back to him now and she's got an angry look on her face and she goes, did you take out that trash like I asked you, yeah, and starts cursing at his wife and yelling at her, like, wow, what what happened?

Well, how did she how did she approach her husband? Aggressive, hostile, angry, what's the fastest part of the brain to respond, the sensory information coming in is angry face and angry tone of voice, the fastest part of the brain to respond is what, the primitive animal brain, in order for that man to recognize, hey, that's my wife talking about the garbage, he needs his memory in his cortex to recognize wife and to recognize the English language, did you take out the garbage?

So when he responded, he didn't respond to his wife, he responded to the aggressive tone of voice and the aggressive face that she presented, now, of course, when he yells at his wife, she don't like that, okay, so she barks at him, then he barks back at her, and now they're in a big argument over nonsense, over nonsense.

They made a their intelligent thinking human brain has made a decision, hey, I love you, baby, let's get married and live happily ever after, let's have a wonderful life together, you're awesome, oh yes, you're such a big strong man, you're going to be a wonderful husband and daddy, but now in the heat of the moment, that intelligent decision, whoo, it's gone, and the primitive animal brain has reacted and gotten them into a situation that their intelligent thinking brain never would have, never would have.

When when the brain is hyperaroused, if it's stressed out, you know, certainly this is a situation that I see in in in military personnel who have have been involved in combat, but, you know, everybody can get stressed out, you know, bills, family relations, neighbors making too much noise, or whatever, okay, that hyperarousal, that primitive animal brain is pumping out stress hormones, interfering with sleep, keeping you up, okay?

It can hijack memory, because as you're thinking of all the stress, even unconsciously, because remember, I'm not talking about the conscious brain where you're thinking and plotting and using your cortex, I'm talking about a hyperarousal of the animal brain that's been stimulated by some type of stuff, okay, could be trauma, could be just day-to-day stuff that's accumulating and hard to manage, but the stress hormones get released, it activates that part of the brain, and memory becomes difficult because concentration and attention, it's not that the memory storage and recall is problematic, it's that the attention is being diverted to all this other stuff.

Okay, the stress factors, for example, I'll have a lot of soldiers who tell me they have memory problems, I was talking to a guy once in my office and we're we had started having a sports conversation, and we get up and walk down the hall and I'm talking about, you know, the topic that we had been, uh, speaking about, we got to the end of the hall and he goes, doc, man, I told you, my memory sucks, I don't remember anything you just said, well, what happened was, when I opened up the door, we retraced our steps to analyze this, so, when I opened up the door, he saw other doors in the hallway and started thinking, who's in those rooms, what kind of weapons they got in there, whose footsteps are those coming down the connecting hallway, what if that guy's a grenade, what are we going to do?

So by the time we got to the end of the hall, he wasn't, he didn't forget what I said, he never heard it, because his primitive animal brain was hyperaroused, so, what are we going to do about it, you know?

I mean, as as a neuroscientist, so I went back to school later in life and became a physician, and I have been fascinated being a brain mechanic, that's kind of what I consider myself to be, I'm not a behavioral health psychiatrist or anybody that deals with mood, depression, all this kind of stuff, but what I love is the way the brain operates as a machine, the most complex machine in the entire universe, and what is really amazing to me is we got this part of the brain that's reacting before we think and triggering hormonal releases and consequently behaviors that really take us in situations that we don't necessarily want, we look back, why did I do that, you know, during the day the brain is constantly generating ideas, constantly generating thoughts, you know.

It goes back to that, you know, I like to think about in terms of ontology, you know, Descartes, 1650 said, there, I think, therefore I am, how did he define his being, I think, therefore I am, fast forward to the 1950s, French existentialist, Jean-Paul Sartre, was concerned not that I think, therefore I am, but I am the person that sees my thoughts, thoughts may happen, but they're generated spontaneously by the brain, they're not necessarily who you are, you are the person that sees those thoughts.

I love that definition, because that's the cortex of the brain that I want to amplify, I want to magnify, I want to use that cortex to determine in my life, how I live my life, what I do, I can see thoughts coming into my head, you know, maybe getting emotional about stuff, angry about somebody challenging me, or cut me off on the road, or or something that's challenging, but it's always good to stop for me, I stop and think, wow, feel my reaction to it, is not necessarily what I want to happen here, what I want to happen, I can control, I can do with my cortex, I still react, because that brain, that primitive brain reacts.

So, in my experience, both in the, I've been working for the for the army for about almost seven years now, and, uh, you know, been a brain injury doctor for a few years, more than that, um, I see a lot of folks in this status who end up going to doctors, and they get headache medications, prophylactic and abortive therapies, they get sleep meds, which don't work, they get mood medications, they get pain meds, okay, you know, oh, let me talk about one more thing I forgot, so stress, right, when you're always walking around, all these muscles are tightening up, you know, you walk around, neck is sore, back is sore, you know, this is this is pain being generated by stress, you know, with headache headache generation, particularly tension and then migraine headaches, neck muscles being tight, you know, from stress, pretty much every soldier that I see that's been to war has this going on, you know.

So, is is the solution to give them headache meds to fix the headache, or do we get to the cause of the problem, let's get to the cause of the problem, this isn't rocket science, okay, a person's stressed, it changes the way their body is operating because of these stress hormones being activated, so we can do things to reduce the stress, you don't need Zoloft, well, I mean, you know, I'm not talking about now psychiatric patients need medications, I'm talking about just cases where there's a clear-cut cause of hyperarousal, hyperstress, okay?

Where these physical symptoms are being generated not by abnormalities in the brain, but by a set of circumstances that is arousing the primitive animal brain to create stress hormones and activation of the thing we call stress, so what we do when we treat the men and women who have gone to war, is try to get to a solution, okay, so how do we treat headaches, send them to a physical therapist, they learn a stretching program, they get devices, heating devices, massage devices to loosen up the muscles, lower the tension that's triggering the headaches, learn sleep hygiene, learn relaxation techniques, okay, we have yoga classes, okay, we teach meditation, meditation has been an amazing tool, you know, meditation relaxes the brain, what happens, physical symptoms get better, headaches, memory, sleep, mood issues, all are improving, okay, exercise, physical exercise is the one I'm probably the biggest advocate of, okay?

We have many many patients who are on profiles, meaning they're not allowed to exercise at normal high level of of of military, so we use these programs to really help the soldiers decrease their stress level and go to an organic holistic solution rather than using the pharmaceutical products, which of course have significant side effects, so I leave you with the message of considering in your own lives how the your primitive animal brain reacts to situations triggering actions and urge you to uh consider alternatives to the pharmaceutical industry, I am about to demonstrate something that I do for relaxation, um, before I was a physician, I was a professional guitar player for many years, and I'm about to plug in this beautiful Gibson Les Paul over here and do a little uh, I'm going to do this as a as as a tribute to the men and women that have served the military, I've had an amazing opportunity in my life to not only be a professional musician, but to go to medical school and become a doctor in my 40s, uh, because I live in this amazing country called the United States, and I play this for all the uh, veterans and current active duty soldiers and people involved with the military who have allowed me to have the freedom to live this crazy life that I've had, so thank you, and this is going to be for you.

Okay, let it rip.