In the words of psychiatrist, Judith Herman, in her classic work, Trauma and Recovery, “… traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning.”  

Human beings have natural and God-given ways of responding to terrifying and stressful events. Even before we are consciously aware of a threat to our lives or someone else’s, our bodies react in a way that helps keep us safe and restore order. The sympathetic nervous system floods the brain and body with catecholamines like dopamine and norepinephrine. It causes a “fight or flight” response with distinctive bodily reactions such as increased heart rate and blood pressure, hair standing on end, and a sudden rush of anxiety and excitement. While protecting the brain and body against harm from this surge of catecholamines, the hypothalamic-pituitary-adrenal (HPA) system floods the body with the stress hormone cortisol. When the immediate threat has passed, the parasympathetic nervous system helps quiet the body, reduces heart rate and blood pressure, and restores a sense of calm.   

Scientists do not know precisely why some people exposed to horrible and life-threatening events develop later problems, such as post-traumatic stress disorder (PTSD), and some do not. However, it is clear this stress-response system has limits—related partially to genes, adverse early life experiences, and the nature and extent of a person’s trauma exposure.  

For many people exposed to horrifying events, particularly when these events are repeated, when the survivor cannot escape, or when the survivor is unable to access adequate support and has to shut down or avoid feeling to keep living, the stress-response system becomes overwhelmed. The survivor becomes stuck in a chronic stress response, with high levels of catecholamines, increased markers of neuroinflammation, and increased activity in the amygdala and other areas associated with threat detection. Likewise, there is often apparent atrophy in regions of the brain such as the hippocampus and ventromedial prefrontal cortex associated with memory and emotion regulation. In this context, vivid and detailed sensory experiences of trauma are encoded in memory. Unlike most memories, though, which form connections to other memories and broader systems of meaning and grow less vivid over time, these memories remain vivid and painfully sharp, like shards of glass on a lake bottom. When they are triggered long after the trauma has passed, the memory and a raging stress response snap back into place, flooding the body again with catecholamines. Sometimes the person may only feel this raging stress response, with no conscious access to the traumatic memory. Simultaneously, this drumbeat of catecholamines is not adequately balanced by the body’s usual way of responding to, and protecting against, stress. Repeated studies, for instance, have shown that people with chronic PTSD often have lower levels of baseline cortisol than the general population.

Over time, this imbalanced stress-response system is associated with broader problems in the brain and body. Partially due to the sustained effects of sympathetic nervous system hyperactivation over time, people with PTSD are at higher risk of poor sleep, increased chronic pain, and chronic gastrointestinal distress. When trauma survivors seek to diminish distress by turning to substances, such as alcohol and opioids, this is associated with significant health risks.  

Just as the body and brain are involved in the formation of PTSD, they are also essential for trauma healing—though not only because of medication. Medications are often useful for PTSD, but most, at best, help manage symptoms. Though they may promote synaptic growth and neuroplasticity, commonly used drugs, such as serotonin reuptake inhibitors (fluoxetine, sertraline, and so on), modify the symptoms of PTSD, but do not heal the condition. Sometimes, medications actually disrupt healing. For instance, benzodiazepines, such as diazepam or alprazolam, inhibit the encoding of new recovery-oriented memories and reinforce patterns of distress-avoidance that can lead to addiction. Medications are helpful for many people, but they are only one part of an overall treatment approach that includes trauma-focused psychotherapy and healthy social connections.      

Beyond medications, however, the body and brain are essential for the healing of trauma. As psychiatrist, researcher, and author, Bessel van der Kolk, comments in his popular work, The Body Keeps the Score, trauma survivors heal when they are permitted to “feel what they feel and know what they know.” Healing occurs when survivors have the safety, space, permission, and support to feel what they would have felt around the time of the trauma and respond as they would have responded had it been safe to do so. This may often be intensely painful and distressing, as when a Vietnam veteran speaks with a therapist for the first time about “that night” on patrol or when a sexual assault survivor writes for the first time about the visceral details of her experience. Physical and psychological safety, a trusting relationship with a counselor or therapist, and healthy support from others are all necessary for healing to occur. When traumatic memories are given permission to emerge, and survivors can safely speak about and feel their experiences of trauma, the brain and body begin to change—forming new synaptic connections, reducing the intensity of the chronic stress response, and increasing the capacity for emotion regulation.

How do these neurobiological observations relate to the way Christians think about trauma and Christian counselors work with trauma survivors?  

First, even as Christians cry out to God for the brokenness and violence of trauma to come to an end, Christians can also praise God for the remarkable ways that our bodies can adapt and respond to overwhelmingly stressful events. We are truly “fearfully and wonderfully made” (Psalm 139:14), with a remarkable capacity for healing the mind and body. Indeed, the Bible provides a template for this healing, especially in the words of the prophets (notably Jeremiah) and in the Psalms. The psalms of lament (e.g., Psalm 6, 13, 22, and 88) give a powerful voice to the aching terror of trauma and to yearning for God to deliver. Just as Jesus turned to the words of Psalm 22 during His own traumatic crucifixion, so also Christians can turn to these psalms to “feel what they feel and know what they know.” In a modern American culture that so often teaches survivors to hide their trauma history and ignore their experiences, Scripture points to a very different direction—one that turns out to be good for trauma healing. At our best, counselors and clinicians facilitate this healing by offering safety, space, and permission for these natural, God-given capacities to unfold.

Second, the fact that trauma is inscribed in the brain and body does not mean it is a problem of the brain and body alone. Christians know from reading Genesis that humans are creatures of the earth who become who we are in relationship with God and others. We are biosocial beings. The way we experience relationships with others, whether healthy or unhealthy, is encoded in our brains and bodies. Our bodies, in turn, both affect and reflect these relationships. While it is true that trauma may be associated with brain circuits and neuroendocrine systems that are not functioning correctly, it does not mean the problem is only, or primarily, a brain issue. The brain may be a sign that the person continues to live in a social and relational environment that is unhealthy or traumatic. The “core” problem might be relational and social, not a broken brain.

Third, this means that Christian counselors, and not just clinicians who write prescriptions and manage devices, can actively work to promote neurobiological healing from trauma. In fact, the most powerful neurobiological interventions are not so obviously “biological.” Most consensus guidelines agree that survivors with PTSD are most likely to benefit from working closely with therapists or counselors trained in a trauma-focused therapy (such as Prolonged Exposure, Cognitive Processing Therapy, or Eye Movement Desensitization and Reprocessing). These therapies allow survivors to experience the full range of emotions and bodily sensations associated with the trauma and learn healthy ways to move forward. The success of these therapies, in turn, is made more likely if survivors are connected to others, have good social support, find their basic economic needs met, and are safe—in other words, if the world is just and healthy for survivors. Healthy and supportive relationships may not seem like high-tech neurobiological interventions—indeed, they are not technologies at all. However, nothing in all of mental healthcare is more powerful for healing.  

Warren Kinghorn, M.D., Th.D., is a psychiatrist and theologian at Duke University Medical Center and Duke Divinity School, and co-director of the Theology, Medicine, and Culture Initiative at Duke Divinity School.

This article originally appeared in Christian Counseling Today, Vol. 25 No. 1. Christian Counseling Today is the flagship publication of the American Association of Christian Counselors. To learn more about the AACC, click here.

Endnotes

1 Herman, J. (2007). Trauma and recovery: The aftermath of violence—From domestic abuse to political terror (New York: Basic Books), 33.

2 Herringa, R.J. (2017). “Trauma, PTSD, and the developing brain,” Current Psychiatry Reports, 19:69.

3 Sherin, J.E., & Nemeroff, C.B. (2011). “Post-traumatic stress disorder: The neurobiological impact of psychological trauma,” Dialogues in Clinical Neuroscience 13:263-278; Abdallah, C.G., Averill, L.A., Akiki, T.J., et al. (2019). “The neurobiology and pharmacotherapy of posttraumatic stress disorder,” Annual Review of Pharmacology and Toxicology, 59:171-189.

4 Yehuda, R., Hoge, C.W., MacFarlane, A.C., et al. (2015). “Post-traumatic stress disorder,” Nature Reviews Disease Primers, 1:1-22.

5 Ibid.

6 Abdallah, C.G., Averill, L.A., Akiki, T.J., et al. (2019). “The neurobiology and pharmacotherapy of posttraumatic stress disorder,” Annual Review of Pharmacology and Toxicology, 59:171-189.

7 van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma (New York:  Viking), p. 341.

8 O’Connor, K.M. (2012). Jeremiah: Pain and promise (Minneapolis: Fortress).

9 VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder (Washington, DC: Department of Veterans Affairs/Department of Defense). (2017). Retrieved January 15, 2021, from https://www.healthquality.va.gov/.