The Sensitive Gut

Understanding IBS

How do we deal with what happens?

Person having a panic attack amidst a faceless crowdHow do we deal with experience?  The quick answer is: we process it in association with previous experiences or thoughts and store it in our database of memories, where it lies forgotten and untended until retrieved by the next relevant thought or experience when it helps us to make choices that allow us to navigate our way through life. Our ability to remember what happened allows us to learn from experience and do it better next time.

Learning

Learning occurs by the association of experience or external representations with feeling states.  Experimental psychologists call this conditioning, which only occurs when mammals are emotionally aroused.  The more we can become inspired and interested in things, the more we will catalogue material into a relevant categories in long term memory and the better we learn.  Just stop and think of what we remember from yesterday. The chances are they are the events that made an emotional connection. So are the things we forget, no longer relevant? Some may be. Others we may actively suppress from consciousness.

The act of remembering and recall is the function of the hippocampus, a tiny structure shaped like a sea horse, buried deep in the temporal lobe of the brain, but we can only hold a limited number of impressions in our mind. If we need to retain an impression of what happened, we need to convert our recent memory into something that can be stored away in our brain alongside other pieces of relevant knowledge and experience. How this actually works was first elucidated over fifty years ago by Eric Kandel by his work on conditioning in the sea slug Aplysia.

Memories are stored as neural networks. Experience is consolidated by the epigenetic activation of genes, which produce proteins, create synapses and make connections so that an action or perception becomes an ‘automatic’ part of who we are and can be eliminated from consciousness until needed. Forgetting may therefore be seen as a healthy process of moving experience into ‘unconscious’ memory, which nevertheless informs our intuition and automatic actions. So my fingers remember the keyboard I am using, the way a tennis player knows exactly how to play a shot, a musician becomes part of her instrument, surgeon and his scrub nurse work as an automatic team, knowing exactly what to do at the right time. These are a form of automatic memory we use all the time, but it can be disrupted the more we think about it. This is why it is so hard to change the way we do things; if we want to perfect our tennis stroke, it has to get worse before it gets better.

Although most may be excluded from consciousness, the vast database of experience and meaning, that is stored in our cerebral cortex is not lost; relevant aspects of it can be retrieved by association with the feeling of what is happening or thought about right now. I tend to think of this process of retrieval as rather like a librarian searching the stacks with a ‘torch’ (representing the feeling).

Remembering and forgetting

If all memory consisted of was a system for storing experience, like a diary or a photograph album, we would never be able to learn anything. But it’s not like that. Research on memory suggests it undergoes a process of revision and adaptation. Recalling something unpicks the genetic code and synaptic links causing us to remember it all over again. The neuroscientist, Karim Nader, working in Joseph LeDoux’s laboratory, showed this several years ago when he demonstrated that giving a drug to block protein synthesis could abolish conditioning.

Memory is a reconstructive process that is continually selecting, adding, deleting, rearranging and updating information by modification neural networks; all to serve the ongoing adaptive process of living and survival. Retrieving a memory allows it to be reconsidered all over again. Every time we remember something, we change it to accommodate new experience and better fit the narrative. The very act of revisiting memories, changes the story. We don’t remember things in the same way as they actually happened; we may omit certain details, embellish others, link events together that were not linked, change the cast a bit to make the memory meaningful and relevant in the here and now. Our current mood and somatic sensations profoundly influence what we are remembering and how we remember it.

Memory is a creative process, a work of the imagination. This doesn’t mean we make it all up; it is more that we create a screenplay that better represents what might have happened. Our memories are not necessarily truth or fact, they are the fiction we create of our lives. Changing memories are the way we make sense of what happened so we can find a way of living with it, so that it fits with the narrative of our lives. As such they may be influenced by therapists, the police, family members, priests, reports of other people, and what we read in the media. We can all be affected by fake news. Memory is a process of myth making and can make us all unreliable witnesses. We may stand up in court and swear to tell the whole truth and nothing but the truth, but truth is relative and only goes back as far as when we last thought about it.

Trauma

We may be able to process traumatic experience if we can put it into a narrative context we can understand. But if what happens is so shocking and outside our experience, we have no basis on which to understand and process it, we can pretend it didn’t happen and not think about it. This is what Freud termed repression?  Sometimes the experience  is so unacceptable that we even dissociate ourselves from what has happened, develop absences or lapses in consciousness, pretend it happened to someone else, escape into make believe or illness?

But memories that are repressed or dissociated memories are not lost. The French neurologist Pierre Janet first realised over a hundred years ago realised that traumatic memories do not fade with time, but are replayed in our implicit or unconscious and influence our characteristic attitudes and behaviour.   The details of the event may be beyond recall, but the feeling and the theme may linger on in our automatic (procedural) memory, where it may colour subsequent experience and guide our behaviour. As William Faulkner wrote in his novel, Requiem for a Nun, ‘The past is never dead. it is not even past. It lives on as a panoply of manifold fears, phobias, physical symptoms and illnesses.’

There may be contexts and associations that may make us feel sad or bring on certain symptoms for no obvious reason. Automatic memories of unresolved trauma can emerge as personal feelings or opinions about certain categories of experience. Common examples include: ‘I can never trust men; they always let me down.’ ‘Everything new always turns out badly’, ‘People never seem to like me’ ‘I can never be good at anything’. Our everyday living experience is always affected by what happened in the past, especially those events or situations we can’t actively recall. It is likely that the most traumatic experiences occur in the vulnerable first few months of life, when our feeling or automatic memory is intact, but we cannot contextualise anything anything into episodic memory. And of course if what has happened occurs in the context of illness or acts through the autonomic nervous system to cause us pain or make us feel ill, then illness too will come to ‘infect’ all subsequent relevant experience. This explains how the psychological disturbance occurring in the context of gastroenteritis, an abdominal operation or sexual abuse can lead to recurrent gastrointestinal symptoms that may be diagnosed as IBS and last for years. But perhaps more relevant are the persistent gut symptoms that are instigated by an autonomic crisis brought on by extreme fear – post traumatic IBS. If trauma is associated with illness, then the illness becomes part of our procedural memory, rekindled by anything that reminds us of the context.

Personality is constructed from our memories.

Over a lifetime, we become a composite of everything that has happened to us; our education, friends, family, the places we’ve lived in, the things that have happened. Every time we recall something we are in effect fine tuning are personality to make it more representative of who we are. But it is not just the things we can recall, our episodic memory, our photographs, writings, possessions and other memorabilia that create who we are, it is also the many automatic aspects of our personality, the way we walk, how we talk, our habits and tics, our reactions to certain occurrences, our attitudes and indeed the illnesses we tend to get – even IBS – all the things that are catalogued in our unconscious procedural memory.

Therapy

In his recent book, ‘Trauma and Memory’, psychologist, Peter Levine suggests that traumatic imprints stealthily force themselves upon us, not so much as stories or conscious memories but as emotions, sensations and behaviours – things that the body automatically does. If that is the case, healing cannot be accomplished by drugs, advice, understanding or fixing but by accessing our body’s own capacity for healing. In order to resolve trauma, you have to find some way of taking bodily action to regain control of our life. Even telling the story is a form of effective action.

Levine does not try to reveal the trauma, he uses body cues, the unconscious reactions to what happened to gain insight into what might have happened so he can replace the frightening memories with more confident ones. The French neurologist, Pierre Janet discovered how trauma could be resolved by safely replaying the old events in their minds while in a hypnotic trance state, and then constructing an imaginary satisfactory conclusion. In this way patients could realise they had survived the trauma and could resume their lives. In a conference, I organised for The IBS Network two years ago, patients who had recovered from IBS were asked to tell how they got over it. In every case, this occurred when they took charge of their lives and changed the context, the environment and their attitudes – in other words, they had revamped their implicit memories.

You can’t change the past, but it does tend to erode when no longer brought to mind. Then you can replace what has happened with new predictions. Look at the way our recollection of our parents change after they die. So many of us retain rose tinted memories though the reality may have been much more mixed. We tend to make caricatures of our memories as we revisit them through the filter of our feelings. Therapy for trauma can help people adjust their life narrative, so that it no longer hurts us.

 

2 comments on “How do we deal with what happens?

  1. carly
    February 24, 2018

    That is a beautiful essay, and very wise and thoughtful.

    Like

  2. nickwread
    February 25, 2018

    Thanks Carly. I’m glad you liked it.

    Like

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This entry was posted on February 23, 2018 by in memory, Post Traumatic IBS, psychotherapy, trauma and tagged .

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