JANILEE: Welcome, friends! You've found just Janilee at the corner of “Am I crazy?” and “No, you're not. Here's the science to prove it.” Today we're going to be talking about a topic that I've mentioned before. There's not too much detail we're going to get into today. But the difference in distinction is most important when it comes to treatment approaches, so we'll get there at the end. But to start here at the beginning, I want to reference you back to episode 2.5, which is on Developmental Trauma Disorder, or DTD. That episode talks very, very well about how being chronically traumatized, especially from childhood, can literally change the way that we function, the way that we perceive things, the way we interact with our environment.  It is very helpful. And if you listen to that first, this episode will be a lot more cool. But if you don't want to listen to that one first, that's also fine.

So what are diagnoses? As we talked about in Monday's episode, we have labels and they can help us find things that we need, whether a group of people that we relate to or medications that our doctor can prescribe us only if we have a certain diagnosis, right? Not everybody who has specific diagnoses is traumatized. So, what's the difference then between people who are traumatized and people who are not traumatized when the label, that diagnosis that they have is the exact same? You’ll remember from past episodes that the term comorbid means more than one simultaneous diagnosis. That [comorbid diagnoses] is common in traumatized people and less common in non-traumatized people. The main difference between people who have been traumatized and those who have not is the layered effect. What do I mean by layered? It leads to those comorbid diagnoses yes, but also the fact that it's not just one thing that's wrong, one thing that's off.

So, when it comes to mental health, when you have an illness there's something wrong with the neurons in your body. Neurons are what is in the brain. You have an entire neural system that goes throughout your body.  But when most people hear neurons, they think “brain”, which is pretty accurate. So if we have our brain, and it's having an illness, then that means that there is something that just isn't working quite right up there. Now, this is not to say that it's something to be ashamed of, right? There's this stigma around labels. And again, listen to our episode four anytime you need a reminder that you are more than your label. But when it comes to clinically looking at this, if neurons are not working - the term often used is “the neurons are misfiring” - then that means  that if we fix the neurons, then the “mental-ness” - the mental illness - will be cured, right?  Yes and no is the answer here. If you have trauma, most likely not.  

Let me think of a better way of phrasing that. If the neuron issue is fixed, then, yeah, you won't have that mental illness anymore. But what goes into fixing the neurons misfiring is a different story altogether, and this is where that layered aspect comes in. When you don't have any trauma layering itself on top of other trauma, on top of other trauma, you have a very simple problem [of] neurons not working. Fix the neurons and you're fine. But with the layered issue, you have the neurons that aren't working AND you have other things that aren't working - and that is the issue. Because when you have trauma, it completely changes everything about how you experience life. So if you were to try and just fix the neurons, it wouldn't work, because that’s not the only thing that's wrong.

Now, before we get into this list, I want to just address the resources for this episode really quick. There are going to be resources linked on the website for the diagnoses of anxiety, ADHD and depression specifically. The two articles that I will be drawing most of my quotes from are going to be “Depression and Psychological Trauma” as well as “The Role of Psychological Trauma in the Cause and Treatment of Anxiety and Depressive Disorders”. So if you wanted to know about a specific diagnosis, check the website. There's most likely a link there. Also, I don't know if I've addressed this before, but if I am doing my research stuff and I find a paper that relates back to a topic that has already been covered on a Just Janilee episode, I will go back into the show notes and I will add that link to the references. So do check back, especially if there's a diagnosis that you're wanting to see how it relates trauma versus non-trauma, let me know and I will find one and I will update the page. So you can do that by the way, through the contact section of our website which is vilifiedpod.com

So back to this whole list of things: neurobiological factors that are affected by trauma. So these are the layers that apply to people who have trauma that don't apply to people who don't have trauma. The first one is a sensitization of the neuroendocrine and autonomic nervous system. Okay, so we know that means that something is getting more sensitive to stimuli, to factors in the environment. But what exactly is? Well, neuroendocrine system and our autonomic nervous system. Well, what are those? Okay, so neuroendocrine. We're going to break that up to neuro, which is relating to the neural network, which we talked about earlier, and endocrine. Now, the endocrine network in our body is what releases hormones.  So neuroendocrine just means anything relating to neurons and anything relating to the glands that secrete hormones. Okay, so those two things get a lot more sensitive. So if they get more sensitive, what does that mean? Well, we already know that we have an issue with the neurons because that's the issue we're trying to fix. That mental illness.

Hey everyone, editing Janilee here. Just wanted to jump in and say that recording Janilee forgot to mention that the autonomic nervous system is the activation of our fight and flight response. That’s talked about later on in the episode so stay tuned.

So what about the endocrine system? Well, when your hormones aren't released… Now, when I hear hormones, before I did any research, I think male hormones, female hormones, the testosterone, the estrogen, everything like that. And that's part of it, yes. But you have so many more hormones in your body than just those. Hormones affect everything when it comes to our bodily regulation. So when it comes to pretty much anything that happens within your body - your internal bodily experience - a hormone is responsible for it. Other than the sex hormones, I’m going to list just a couple of other common hormones that you probably will recognize. And these are ones that, again, you need those glands to regulate properly in order for your neuroendocrine system to work. You have adrenaline, that's a hormone. Insulin is a hormone. Oxytocin. We're actually going to be talking about that later on in the episode. Cortisol is a common one that you hear in terms of trauma because people who are chronically traumatized have dysregulated cortisol levels very often. You have thyroid hormones. Melatonin is a hormone as well. Dopamine. Now, a lot of these are ones that we're probably not going to be aware of when we're not actively thinking about hormones or when we're not actively experiencing them. It's very important to know that whether we're aware of them or not, they are inside of us and they are functioning, and when you're exposed to trauma, that aspect of your body is off. It's not really working right.

I mentioned oxytocin. Let's just jump to that one as well. Let me find the quote.

“Another neurobiological mechanism altered by early trauma is in relation to the neuropeptide oxytocin. This neuropeptide has an important role in mediating social affiliation, mother child attachment, social support and trust.”

That's fun. That's a lot of things. Sometimes oxytocin is also called the bonding hormone. When you have that mother child attachment… if you've ever seen someone right after giving birth, doctors and nurses nowadays will recommend skin to skin contact. That actually increases the production of oxytocin, which allows that child to feel safe and allows them to build trust, right? So if you have a decreased level of oxytocin in your body, in your nervous system - you might have experienced childhood trauma. Because of the disruption of you building that bond and that level of trust with your caregiver. Think back again to the episode on DTD how if you are experiencing a hard environment or an unknown environment, if you are bonded with your parent, it's not as bad, even if your parent has no idea what to do. And I'm saying parent, but caregiver also works here.  So you have decreased oxytocin.

Another thing is you will have “increased immune activation”. Okay, so increased immune let's see, increases up “immune” sounds like immune system, I guess. Okay, so our immune system protects us against getting sick. Okay, so basically when we have an increased immune system…  Well, what's it increased against or for? Well, it's an increased immune activation, which means that the activation of the immune system goes up. I'm saying, “which means” a lot. Trying to help walk through the thought pattern. So an increased immune activation means that your immune system is being activated more than is normal/healthy it. When you have an overactive immune system, that's almost just as bad as having an underactive immune system. It means that your body is putting forth far more energy than it needs to, to try and protect you from invading pathogens, to protect you from getting sick. But what happens because of that is your body gets overworked - you're very often, very tired. Often you also have digestive issues.  You can have fevers, which is your body getting sick. When you have a fever, it's your body trying to fight off something. And so if there's nothing to fight, if your body is still fighting, you'll still get a fever, which means that you're sick for no reason. You're not sick because you're fighting off something. You're sick because your body is fighting… nothing.  So our body doesn't adequately learn how to deal with any kind of potential threat, which again goes back to that not really knowing how to interact with our environment and not being secure in our internal world.

Another thing that happens in that layered effect for those who have been traumatized is reduced hippocampal volume. Okay, so hippocampal is just a way to say that we're referring to the hippocampus of the brain. The hippocampus is part of the brain where we learn and remember. So it's those cognitive functions which most likely means that we didn't do great in school. But simply put, when you have your hippocampal volume being reduced, you learn not as well and you remember not as well as compared to those who are healthy, who have a regular sized hippocampus.  

Another part of the brain that is affected by this layered  system dysregulation is the frontal limbic system. So what does that mean? Well, the frontal limbic system refers to our frontal lobe, which is the brain that's right behind our forehead and the limbic system, which is at the base of our skull/the top of our neck. Now, the limbic system and the frontal lobe they're connected and they have a system that helps them work together. It combines humans’ higher cognitive processing with their more lower animal instincts. It combines, if you've ever heard of the term, the “reptilian brain” versus the “mammalian brain”. So basically our brain has two aspects to it and the frontal limbic system is what combines them together. The most direct impact that dysregulation of the frontal limbic has is an inability ability to effectively process and regulate emotions.  Also a big deal. I'm not sure what else to say about that. I mean, a lot of these things are more of just we notice these patterns in the Developmental Trauma Disorder episode but now we're finding out kind of the science behind why they are things, right?

Continuing down the list, I have a quote here:

“The effects of childhood trauma on later vulnerability to stress and disease are also moderated by genotype.”

For that aspect, refer back to our episode that we had on Epigenetics. It's that fancy way of saying you have gene expression and you have the power to change them - you have the power to change the gene expression. But how we go about that is a whole fascinating subject on its own. So refer back to episode 3.5 on Epigenetics for that one.

One other thing that is listed on these neurobiological factors of people who are chronically traumatized rather than clinically diagnosed is an increased central corticotropin releasing factor. I actually had to look up what the corticotropin releasing factor was. That was not something that I just knew off the top of my head, so I learned something new! Once I looked up what it meant, though it did ring a bell.  It is related to the unbalanced neuroendocrine system we talked about earlier.  The corticotropin releasing factor, or CRF, is what tells the brain “you need to release some hormones”.

So let's use a simple example to kind of visualize this. When you have that fight or flight response, which is the activation of the 10th cranial nerve, the vagus nerve, your CRF that corticotropin releasing factor senses, it receives all of this input from your external senses, like your eyes, and says, “Yeah, no, we got to go. We got to run, or we got to just stop moving and pretend we're a tree.” And so it tells our neuroendocrine system, “YO, we got to get going. You need to release this hormone to give the body the necessary energy it needs to deal with this situation.” Oftentimes the hormone that's released in these situations is cortisol and/or adrenaline. Adrenaline is usually released when we're going to flight, when we're going to run, but cortisol is released regardless of the flight or the freeze. Also, adrenaline can be released for the freeze response as well.

Using terminology mentioned in the DTD episode. If we are living with the bear, right, we're not just coming across the bear in the forest, but we're living with the bear, then that CRF is constantly telling our brain to excrete this hormone. And our neuroendocrine system gets really messed up because it's just like, “At what point do we have to stop releasing this hormone? Like, can we relax? We're getting overworked.” Our immune system is getting so sensitive to every little thing because *SIGH* there’s just too much happening. And then we get sick and then our body shuts down.

So when we're looking at mental illness from a bird's eye point of view, right? We have neurons that aren't working, but what else isn't working? Is the CRF factor working? How's the immune system activation? What's the size of the hippocampus? What about the oxytocin levels throughout the entire body? How's the genotype expression going on? What about a frontal limbic pathway? How is that shaping up? When we're looking at trauma-based diagnoses versus clinical diagnoses, the difference is in the layers. When you have a clinical diagnosis without any trauma, you can treat the neurons and make them work right, and you'll be good. But it doesn't work so well with people who are traumatized.  It's an interesting section of the research. Says this:

“One study found that patients with chronic depression and early trauma responded better to psychotherapy alone versus a pharmacotherapy.”

Okay, so psychotherapy is different types of therapy. It's dealing with that layered issue of trauma and taking it apart and putting the pieces together in a way that works for us while discarding the pieces that don't work for us, right? Whereas pharmacotherapy is psychotherapy plus medicine. So thinking, for example, I take antidepressants and that affects how my brain works, how my neural pathways work, which the next JJ episode is actually… surprise! Going to be a Just Larissa episode, but the Just Janilee episode after that one is actually going to be on the neurobiology and neurophysiology of the nervous system, the physical body. So we're going to really get down and describe on the smallest level possible how antidepressants work and how our neurons should be working, what it looks like when a neuron fires properly versus improperly.  So come back for that one, if that sounds interesting to you…

Coming back around to these clinical versus trauma induced diagnoses is usually how I think of it. The biggest difference lies in the treatment, right? Whereas people who are traumatized, they respond better to these psychotherapy because it's dealing with the root of the problem. It's not just putting a Band Aid on the issue, hoping it'll go away, which, unfortunately, some caregivers do that. They put you on some sort of medication and say, “Good luck” Whereas ones that actually care. For instance, when I went to my primary care provider to get this prescription of antidepressants, my primary care provider, my doctor, was adamant about making sure I was also seeing a psychologist, but I was also going to therapy. My doctor was like, “Yes, you need antidepressants, but you also need therapy”, because she was able to recognize this is not just something messed up with the wiring in the brain. Yes, there's that, but there's also other issues that relate to it, and we need to make sure we're addressing the root of the problem so that we can figure out what's going on and fix it.

Speaking of me taking antidepressants, though, I think a really good example to illustrate the difference here can be shown in when I started taking an actual antidepressant, the first antidepressant I took actually made my suicidality a lot worse. I had a very adverse reaction to it, and by the time I stopped taking it and switched to a new medication, I was having manic episodes three to four times a day. And for anyone that's had a manic episode, they are exhausting, and you know. You know how exhausting they can be. But when you have this manic episode, for those who haven't, you're essentially just going from high to low to high to low. It's almost like bipolar, but not in just mood, but in energy as well. And you're aware of it happening, I could tell, like, “Oh, I'm going to be manic. I don't care.” And then you just kind of go with it. At least that's how it was for me.

But when I started taking an antidepressant that actually worked for me, when I got off of the one that didn't work for me and got onto the one that did work for me, I immediately saw that my manic episodes stopped, right? It fixed that wiring of the brain, per se, so that that was causing the manic episodes so that I could breathe and make it through a single day without a manic episode. I had, I think, only two or three manic episodes after starting a good antidepressant that worked for me, but it didn't cure my depression. I was still extraordinarily suicidal. I was just more calm and the stereotypical version of depressed, because the manic episodes had stopped.

Now, because of the way the brain chemistry works, it takes about six to eight weeks for an antidepressant to start taking effect. And I remember it was about six and a half weeks after I started taking this antidepressant.  I woke up in the morning, I was getting ready to go to work, and I heard a bird outside, and it chirped. And as I was putting on my jacket, there was a ray of sunshine came in through the window into my room.  And I had the thought, “Huh, that's nice.” And I just froze because having the thought “huh, that's nice” hadn't happened to me. It was so foreign because I hadn't felt that way in a long time. At the time I was taking vitamin D supplements. I was spending time in the sun. I was trying to write down a gratitude list. I was doing everything that people say you're supposed to do to treat depression, and none of it was working. And then once this antidepressant started soothing over my nerves, right? It wasn't just the removal of the one that was aggravating the nerves and making it worse and creating those manic depressions, those manic episodes, but actually a new one came in and soothed the process.

I was able to see things differently. It was like… I came up with this analogy because I was putting on my jacket when it happened. It's the analogy of a zipper. Let's say that you go and in your entire life and you've never heard a zipper sound in your entire life.  And you've never heard a single zipper sound. And people keep putting the zipper closer to your ear. “Don't you hear it? Don't you hear it?” They're unzipping and zipping over and over again. “Don't you hear it? Don't you hear it?” And you're like, “NO! I don't hear it.” And you walk by people every day, people who care about you, people who genuinely want to help you, and they're moving the zipper up and down, up and down, and you're like, I don't hear anything. And they're like, “Well, if you were in the light, you could hear it. Well, if you wrote down a gratitude list, you could hear it.” And you're like, “I am doing all of these things, and I still don't hear no damn zipper.” And then one day, they're putting on their jacket and they hear the zipper.  You just kind of freeze in that moment. I heard the zipper right now, that shows that certain number of layers had come undone for me to get to the point where I can still find joy in being in the sunlight.

I went outside earlier today, and it was windy, and my dog chased a leaf for about 15 seconds, and it made me smile. My ability to smile at things like that comes from years of therapy and healing, but it also comes from antidepressants. I needed both because I was traumatized from the time I was a child growing up, my brain and its size and its chemistry is literally altered. It's grown up, and it's matured in a very unhealthy way. And it needs these aids. It needs the aid of antidepressants to work and function correctly. That alone is a clinical diagnosis. But in order for me to live a happy, fulfilling, deep, meaningful life, that also required therapy and that also required healing.

So it's not that there's anything clinically different. The symptoms are similar, things are the same this way and that way on the surface level, but diagnoses born out of trauma have this layered effect. You get to the point where you can hear one zipper, but you got to keep working, you got to keep working down through all of the layers…  and at some point you hope that it's going to end. But I don't know if it ever does, at least not for me. And that's where it comes back to being more personal, that personal way of seeing an actual diagnosis. Is it good, is it bad? Or is it personal?

So hopefully this helps in explaining how you have these surface level: the neurons aren't working. Yes, they're malfunctioning in the same way between a traumatized and a non-traumatized person. And medication and modern-day science can help with those things. But the deeper level, that's something that you're going to need therapy to help fix. But don't worry, because we're already working on it now. I'm just going to end it after therapy to fix. But don’t worry because we’re already working on it!