Societal Trauma and Resilience: A Path towards Recovery, Empowering Women, and Epigenetics

Societal Trauma and Resilience: A Path towards Recovery, Empowering Women, and Epigenetics

Ana Cecilia Duarte, Arezoo Hajighorbani, and Jim Stellar

In our last short blog on brain reward, societal trauma and resilience, we suggested that some help with resiliency could come from finding ways to increase reward experiences. Releasing dopamine, even in small ways, we suggested could be a factor in providing some resiliency as a bottom-up influence in the brain. However, top-down brain mechanisms are also important, particularly where the trauma is not just in the past but continues in the present as a form of racism, sexism, political persecution, etc.

Following a call for new brain research (and epigenetic studies), a 2024 meta-analysis study of fMRI research looked at cerebral cortical mechanisms, basically we think a top-down approach. It suggested cognitive brain structures that could be involved, including the default mode network and areas where somatic reactions are processed like the insula cortex. These are brain areas that we have previously written about in terms of cognitive-emotional integration and learning from experience in college students. While that work is important, the issue of resilience from trauma we see as urgent. Without better understanding of changes imposed at a brain and behavioral level and without early interventions, particularly after childhood trauma, disenfranchised populations will continue to have poor health outcomes that universally challenge public health. The aim of this blog post is to begin to address some of these brain-behavior issues from the perspective of cognitive-emotional integration and to tie them to culture and society.

Trauma

The Default Mode Network and trauma: The default mode network is a collection of brain regions starting in the planning/motor medial frontal cortex but extending back to the angular gyrus and the sensory processing parts of the brain. It was first discovered when subjects were waiting in a brain scan for the experiment to start and began to mind-wander or daydream. But it now seems to be more than that. In terms of the self, the default mode network is also involved with autobiographical self-referential thinking, particularly about one’s own emotions. It seems to have social implications such as thinking about the emotions of others, moral reasoning and it seems to be involved with remembering the past and thinking about the future. This network is known to be involved in studies of PTSD and of depression.

So, how could it work in trauma, particularly the kind discussed above? In the first study, a mild affective stressor was shown PTSD to reduce default mode network activity but that effect did not happen in depressed patients. In the second study of depressive patients, the default mode network was characterized by those researchers as less stable than in normals. We now know from another study that stress interferes with the Default Mode Network, disabling aspects of its function. Furthermore, trauma in childhood has been shown to do the same thing in disrupting the default mode network function and it seems to interfere with the insula cortex (which is involved with risk) and other systems such as those that involve self-referential thought. Such trauma has also been shown to increase dissociative identity disorder (or DID), particularly when it is repeated in childhood.

Adverse Child Experiences: Mounting evidence reveals a strong correlation between adverse childhood experiences as the etiology of chronic illness– highlighting the need to address trauma as a major pressing public health crisis. Children from marginalized communities, particularly those subjected to prolonged cruelty, neglect and exploitation have a higher propensity to develop trauma-related dissociation, a subtype of complex PTSD that can progress to dissociative identity disorder (formerly known as multiple personality disorder). Disrupted early neurodevelopment can severely compromise the integration of cognitive, emotional, and behavioral processes– challenging the resilience of the human spirit. The prevalence of trauma-related dissociation and dissociative disorders, like DID, has been shown to be more prevalent than other common psychiatric conditions, such as bipolar disorder or schizophrenia. The pervasive impact of systemic barriers such as access to health care in addition to the scarcity of trauma-informed care among clinicians significantly impedes the accurate diagnosis and effective treatment of this controversial condition. The variability in the clinical presentation and therapeutic approaches for this disorder poses significant challenges to accurate diagnosis and optimal treatment, impacting patient outcomes. Some hope comes from an interdisciplinary approach to mitigating health disparities in marginalized populations by integrating epidemiology, epigenetics, and neuroscience. While these disciplines are distinct, their convergence offers a powerful framework for investigating the intricate relationship between genetics, environment, and disease.

Adverse Fetal environments: Trauma, particularly during critical developmental periods, can have a profound and enduring negative impact on health and well-being, often manifesting subtly and insidiously. David Barker, a renowned epidemiologist and physician, made significant contributions to the field of public health by conducting groundbreaking research that highlighted the impact of food insecurity on pregnant women and their infants during the 1944 Dutch famine, a period of time marked by severe food scarcity and starvation. By analyzing these birth records, Barker found a higher prevalence of low birth weight infants and of mortality. Barker’s hypothesis, known widely as the fetal programming of adult disease, suggests the long-term consequences of maternal malnutrition and stress during pregnancy. The hope is that building upon Barker’s  research, researchers today are delving deeper into the interplay between genetic predisposition and environmental exposure that shape human health and development.

Epigenetics: Just as adverse fetal conditions can have lifelong health implications, childhood adversity, including  domestic violence and poverty, can also have significant and enduring genetic consequences leading to an increased vulnerability to a wide range of physical and mental health problems throughout the lifespan. A recent paper explored epigenetic mechanisms by which childhood trauma can alter biology and have detrimental health consequences. While multiple epigenetic mechanisms may be involved, DNA-methylation has emerged as the predominant manner of epigenesis. The recognition that DNA methylation patterns can be intergenerationally transmitted has profound implications for our understanding of generational trauma. Trauma, a pervasive and  silent epidemic, has far-reaching consequences for individuals and societies globally. By recognizing the epigenetic mechanisms through which childhood trauma can influence health outcomes, we can better understand its significant impact on public health. One review suggested that low maternal care of rat pups resulted in specific DNA methylation changes, which could be reversed by cross-fostering the pups with nurturing mothers.This finding emphasizes the substantial potential of epigenetic interventions to alleviate the long-term ramifications of childhood trauma.

Brain Neuroplasticity: The first 1000 days of life– from conception to a child’s second birthday, is a period of extraordinary brain development. During this critical window, the brain undergoes rapid growth and forms billions of connections throughout the brain, laying the foundation for future cognitive, emotional, and social abilities. These neural connections are fundamental to future learning, memory, decision-making, and emotional regulation, both intrapersonal and interpersonal. Early-life stress can disrupt the formation of these connections, increasing the risk of mental illness by triggering epigenetic changes that increase the risk of major depressive disorder, as indicated by a recent review. Neuroplasticity refers to the brain’s ability to reorganize itself by forming new neural connections throughout life, a process crucial for learning and recovering from injury. In the context of major depressive disorder and stress-related disorders, such as PTSD–  neuroplasticity becomes impaired, changing the delicate tapestry of the brain.

Here we must look at the hypothalamic-pituitary-axis (HPA). Several key brain regions are disrupted by the effects of stress and result in significant changes within the limbic system: The hippocampus shrinks and the amygdala increases in size, leading to heightened emotional reactivity and overproduction of stress hormones. These changes come with important sex dependent hormone responses in the HPA. In men, testosterone has a dampening effect on the HPA, leading to a reduced stress response, whereby estrogens can increase it. That observation suggests a potential heightened sensitivity of females to epigenetic modifications caused by early life stress. That emphasizes the imperative need for gender-specific research, given the past predominantly male focus of historical healthcare research. Of course, first women (and men) deserve the opportunity to live a life free from the enduring impact of trauma.

Somatic marker hypothesis The somatic marker hypothesis was first developed by Antonio Damaiso’s research group to explain why a patient with ventromedial prefrontal cortex damage seemed to be unable to make simple decisions (e.g. when to come back for another doctor’s appointment) while he still could relate complex facts and theories (e.g. about two rival baseball teams and which one was likely to win). The idea was that he had lost the gut sense underlying the simple decisions. We might say that next week feels right for that come-back appointment). That idea of feeling guiding decisions morphed into an idea that the body could influence the cognitive brain, particularly through the emotions. A good example is someone who has a bad experience in a particular location. The experience leaves the person feeling uncomfortable when they return to that site and it is seen through a racing heart, sweating palms, etc. It is almost like the body remembers and that signal reaches the cognitive brain. In this formulation, it is not necessary for someone to even consciously know that they are uncomfortable. They just avoid the location and if asked may just say that they do not like it. One can readily see how this process can relate to trauma.

When Trauma Becomes Culture: How Systemic Oppression Paralyzes the Brain

In many parts of the world, women (as an example) are subjected to environments where trauma is not just an isolated incident but a persistent, recurring experience. In some societies, women face public violence and systemic oppression as a means of control and suppression. For instance, acts of brutality, such as public beatings for demanding equal rights, illustrate how trauma is utilized as a tool of oppression. These acts not only inflict immediate physical harm but also serve to instill a deep-seated sense of fear and helplessness, reinforcing societal norms that subjugate women. The trauma inflicted upon women becomes a part of the cultural fabric.

The constant exposure to stress and deprivation of rights creates an environment where women’s experiences of trauma are normalized, further entrenching the cultural and societal norms that sustain it. Consider a scenario where women’s brains are continuously subjected to stress due to restrictive laws and societal limitations. This ongoing exposure to trauma conditions leads them to operate under constant duress, affecting their mental health and overall well-being. Legal and societal frameworks that routinely impact women’s rights only exacerbate this situation, creating a systemic environment of stress and trauma. Trauma, when it becomes a pervasive and systemic element of a society, can effectively marginalize entire groups, particularly women. When individuals are subjected to constant trauma without access to treatment or support, the resulting symptoms can entrench them in a cycle of suffering that becomes increasingly difficult to escape. This cycle of trauma not only affects the individuals directly experiencing it but also impacts future generations, as the experiences and mindset of trauma are passed down from mother to daughter and beyond.

The ongoing exposure to such harsh conditions can lead women to internalize the trauma, making it seem as though their cultural and societal constraints are insurmountable. This normalization of trauma can become so ingrained that it is perceived as an unchangeable aspect of their existence.

A striking example of this dynamic can be seen in the way some societies justify excluding women from high-level positions, such as judges, by arguing that women are inherently less rational. This rationale often ignores the profound impact that constant trauma and systemic discrimination have on cognitive function and emotional stability. The critical question we must ask is whether we have truly considered the implications of placing individuals, particularly women, in environments where they are systematically retraumatized by societal structures. The cognitive and emotional challenges faced by women in these settings are not inherent flaws but rather the result of a culture that perpetuates trauma and denies adequate support and recovery.

Non-stressful environment for pregnant women to address the mental health of the child and adverse effects of racism and sexism. Gender discrimination significantly affects maternal mental health, leading to adverse outcomes for child development. Mothers who perceive themselves as experiencing gender discrimination are more likely to suffer from depressive symptoms, which are associated with increased emotional and behavioral challenges in their children. This highlights the intergenerational transmission of stress, emphasizing that the effects of sexism extend beyond the mother to impact both boys and girls. Additionally, financial hardship emerges as a critical factor that can exacerbate these issues, suggesting that addressing economic stressors is essential for creating a nurturing environment for expectant mothers.

Sexism in Trauma: Sexism in trauma refers to how gender-based violence or discrimination shapes and impacts the experience of trauma. Women are disproportionately affected, even within therapeutic settings, where biases can persist. Cultural and intersectional challenges often exacerbate sexism in trauma, and seeking help may carry stigma for women. In patriarchal societies that devalue women, their trauma is frequently dismissed or unrecognized. For instance, women may be blamed for their appearance or behavior prior to an assault, implying they are responsible for the attack. Conversely, men’s emotional trauma is often overlooked due to societal expectations that they should “tough it out.” Additionally, women of color often face compounded discrimination and inadequate support, even in critical areas like childbirth.

In Conclusion

We have barely scratched the surface. There is no conclusion as there is so much more to say about this issue and closely related issues.  We will be back with more writing.