In the past mental health issues have been attributed to a “chemical imbalance.” Researchers suggested that neurotransmitters like serotonin and dopamine and variations of these chemicals in the brain could lead to issues like depression, anxiety and other “disorders.” Today, most would refute this claim. While there may be an imbalance of neurotransmitters, this doesn’t prove cause, just a possible symptom of a more complex issue.
It is my opinion that mental health issues are a trauma state, a sort of “injury” to the nervous system created by long standing or shock stressors. In my understanding and experience, even issues like personality disorders are trauma reactions and in this article I will give examples relating to them.
It is also my opinion that people suffering from these trauma reactions and often learned behaviors that at one time helped them navigate daily life, can change.
The very term used to describe these states , “disorder” (anxiety disorder, major depressive disorder , borderline personality disorder )implies something very wrong with the person. While the state is causing suffering, it is also a normal reaction to extreme conditions. There was nothing in the past disordered about surviving .
The behaviors and way of thinking became hardwired and the person living in this trauma state is not always fully aware that these reactions to the outside world is not authentically them, but a reaction from the past. They may also not have enough awareness to know that it is possible to access the more authentic part of themselves, because much of the time they are seeing their present through a faulty lens. The lens of past experiences is dictating their interactions with the world now. Once the lens changes to the present, so can the interactions with it.
I prefer using the word reaction to describe the person’s state. Of course these reactions cause a lot of suffering, but in my opinion , this is what they are- reactions to the threats around them both real and perceived. If one has a history of chronic traumatic experiences the nervous system shapes around these experiences, therefore the person’s neuroception is impacted. Neuroception is the systems subconscious process of detecting threats around the environment As the child grows threats seem to be all around, even on a subconscious level. The slightest cue of “danger” activates the emotional center, the limbic region. The system detects this threat and then activates the amygdala which then sends a signal to the hypothalamus triggering the bodies fight, flight or freeze.
In short, there was not enough safety for the child to co-regulate with a caregiver leading to faulty neuroception and poor coping mechanisms to chronic fear of danger. Of course, mental health issues could come about later in life and may not be related to upbringing. A chronic or shock trauma could occur at any time, leading to dysregulation. But , if a child starts with a resilient nervous system based on healthy co regulation, it has a greater chance of bouncing back to baseline even after stress.
Nervous system states can best be explained by Polyvagal theory by Stephen Porges.
There are three main principles of the polyvagal theory.
Polyvagal theory describes the science of feeling safe enough to fall in love with life. – Deb Dana
POLYVAGAL THEORY THREE PRINCIPLES:
#1: Hierarchy of the polyvagal ladder.
Dr Stephen Porges describes the three evolutionary stages involved in the development of our autonomic nervous system. As he states, there is a hierarchy of responses built into our autonomic nervous system. Depending on our neuroception, in our daily life we will have moments we feel safe and authentic, moments of “danger” and moments we may feel trapped. In each state, there will be physiological changes and patterns of behaviors , thoughts and emotions that arise. For example, if you are late to work, your heart may begin racing, thoughts of “I am going to get fired”, may arise. You may even start to feel fear. The body will mobilise to get to work as quick as you can, even running. This is an example of a sympathetic state.
Dorsal vagal state can lead one to feeling disconnected, shut down. For example, a woman who was abused by her mother may feel immediately disconnected , even numb when in her presence.
It is healthy and normal to move between states throughout the day.
We move up or down this ladder in everyday life , the more time we spend in one state, the more likely it is to get stuck there. Our system can also become hyperactive with impaired neuroception. In other words, it may start to perceive cues is the environment as threats when they are not.
Also, there are combination of states , for example, play can be considered a combination of sympathetic and a ventral vagal state. Meditation can be considered a combination of dorsal vagal and ventral vagal. The goal of a healthy autonomic nervous system is not to remain in a ventral vagal state but to respond appropriately to what’s happening.
Principle #2 – Neuroception
Neuroception is continuously scanning the inside, outside and interpersonal environment for threats of danger. The brain communicates with the body by way of the vagus nerve which activates a sympathetic or parasympathetic state. A healthy nervous system is flexible and can recover more easily from stress. The vagal brake works like a bicycle brake, if you are going “too fast” the brake helps to slow you down in times of stress. If you are going too “slow” meaning not responding appropriately to a real threat because you are disconnected, the vagal brake, reduces in order to mobilize you.
Impaired neuroception can reflect in seeing cues in the environment as threats when they aren’t. For example, if touch often meant being beaten rather than being soothed as a child or even later in life, a system can go into fight, flight, freeze or fawn when someone tries to show affection. Once activated, a person without the foundation of regulation skills from infancy co-regulation with caregivers may over react and become highly emotional or even frozen at touch.
Through a process of neuroception, those with trauma may associate many interpersonal cues that are minor like tone of voice, body posture, words used as dangerous and they may move into mobilisation (sympathetic state) quickly and drastically, in an effort to protect themselves from what they perceive will happen. Once in mobilisation if they have not been provided the skills necessary to return to social engagement (ventral vagal), they will get stuck in the sympathetic or dorsal vagal state. There is a neuroceptive mismatch where the person cant turn off the alarm system. Cues of safety aren’t registered and they remain hypervigilant. Here you may see someone who loses control of their emotions, rages, cries etc. They can’t seem to stop since their nervous system never developed the capacity to do so.
Others may move directly into a dorsal vagal state of freeze and shut down, not knowing a mobilization state is available. Perhaps in the past emotions that went with mobilization like anger or other was unsafe. They may have been mocked, invalidated or abused anytime they exhibited an emotion. They could also have picked up more subtle cues that emotions were just not accepted. The environment was just not safe enough to express how they felt. Their system learned to go directly into freeze into a state of hopelessness, dissociation and collapse.
As the child grows the neuroception gets stuck in one of these survival states and results can be be emotional lashing out, temper tantrums, depression, panic attacks, inappropriate anger, or even more subtle behaviors like lying, manipulation, discard. The foundation of neuroception is co-regulation beginning in the mother’s womb.
Principle #3- Co-regulation:
Co-regulation is a process where people interact and modify each others nervous system states and behaviors. It begins in the womb. An unborn baby will begin to pick up cues of safety or danger before it is even born. A mother’s voice, outside noise, mothers movement, can help to soothe a growing fetus calming it down, or may cause dysregulation as the development begins. During the first three years of life the cues from caregivers promote the development of the brain which is a social organ, meaning we need connection to thrive.
Social cognition in humans is distinguished by psychological processes that allow us to make inferences about what is going on inside other people—their intentions, feelings, and thoughts. Some of these processes likely account for aspects of human social behavior that are unique, such as our culture and civilization. Read more about this here.
Stress in the short term does not affect the infant negatively, however chronic stress in a mother does. A developing fetus can sense through cues a dangerous or safe situation. Chronic stress led to a baby being born with learning deficits, anxious behaviors, reduced attention, altered immune function, and altered cardiovascular responses to stress. After birth, the parents role in co-regulation shapes the child’s nervous system. As their nervous system develops they are learning responses to the environment as well as about themselves from the parent. When the child is left on their own to cope with any kids of stress they will move first into the sympathetic nervous system (fight, flight). If the caregivers continue to ignore their need for co-regulation, the system will move into the parasympathetic state (freeze response), which can be misinterpreted as the child self soothing since they are quiet.
Unfortunately, without the proper modeling and a fully developed nervous system they are not capable of self soothing, and require the co-regulation to identify, understand and soothe their emotions. The child’s attachment style develops from the caregivers ability or inability to co-regulate. Inconsistent, neglectful or even abusive responses to a child’s distress will push their system into different nervous system states and behaviors to get their needs met. For example, if a mother yells at a baby who is crying about how it is affecting her sometimes and other times completely ignoring it, the message it is receiving is that the mothers needs are more important.The child may not learn healthy self regulation skills, instead fawning (trying to do for others) and/or freezing during times of stress.
Chronic situations like this are traumatic to the child’s system and can result in getting stuck in freeze and fight/flight states.
Examples of Mental Health Issues
There are 10 specific types of personality disorders in the DSM 5. They all exhibit long term dysfunctional patterns of behaviors as well as ways of thinking of oneself and others. For the purpose of this article, I will only speak about two, borderline personality disorder and narcissistic personality disorder.
For example, for people with BPD, minor situations that wouldn’t impact other people can cause an extreme physical response. This can create extreme stress and anxiety, even if the stress is caused by delusions. For instance, if a person with BPD believes their partner is going to leave them, they may become panicked and distraught, even if their partner has no intention of breaking up with them. Their heart may race, they may cry, and they may feel a rush of adrenaline and take a rash action to prevent their partner from leaving. You can read more about this here.
The system detected a threat, based on cues from the environment that were overcoupled with fear of abandonment. Sometimes, the fear is actually rational since people with BPD tend to gravitate towards the familiar. Having been raised in an environment with a caregiver who is emotionally unavailable the pwBPD often will find themselves in similar relationships. It is the response of losing control that is extreme.
As infants and children, parents are supposed to help regulate by labeling, soothing, encouraging, supporting and mirroring. For example, if a child is crying, the parent is responsible to help the child label the emotion they are feeling, and then soothe them to regulation or model a calm state from which the child can mirror.
However, if they are not able to do this, the child is left without these regulation skills and with emotions they do not understand. Further, abuse such as mocking the child for crying, threatening or even hitting or walking away from them, exacerbates the survival state they are in and leads to panic and fear of being alone in crisis, as well as shame and guilt.
The nervous system lacks a foundation of resiliency and can become hyper reactive. fight or flight center becomes hyper reactive and even has been shown to be smaller on brain scans with increased activity. Trauma leads to these changes in the size of the emotion center. You can read more about that here.
In the case of someone with npd (narcissistic personality disorder) the cues of danger of abandonment lead to a dysregulated state , which the pwNPD then tries to regulate by using manipulative tactics like devaluation and discard. These coping strategies like the pwBPD were created in childhood in an attempt to self regulate in the time of emotional crisis. If a child is crying and a mother is unable to soothe the child, they may go into their own inner world and repress the fear.
Coupled with caregivers who may be abusive while at the same time may soothe the child with material things as well as placing emphasis on the appearance and successes creates a push/pull dynamic. The child is emotionally abandoned but is able to gain some attention for the way they look, or success in school etc. Of course it is much more complicated and you can read more about NPD here.
Narcissistic personality disorder is less studied and written about because those who exhibit these traits seek help less often. The person with NPD has by definition what appears to be an inflated sense of self, but it is actually masking a deep insecurity. The neuroception of the pwNPD is impaired and like BPD there is a higher sensitivity to environment.
Royce Lee MD, found higher levels of oxidative stress in those with these traits.
Additionally, the study found that NPD represents a disorder of hypersensitivity. When dealing with interpersonal stress, someone with NPD might appear aloof on the outside. But on the inside, the study results suggest it’s actually hypersensitivity to the environment. That means there could be a possible relationship between oxidative stress and how people act on their emotions. You can read more about that here .
Anxiety disorders also can be looked at through a polyvagal lens, and often anxiety is the beginning of the development of a personality disorder or even PTSD. It is estimated that 4% of the global population suffer from an anxiety disorder. Chronic or shock trauma can dysregulate the nervous system leaving one in a sympathetic nervous system state or dorsal vagal state which becomes the default. The ventral vagal system is hard to access in someone with anxiety disorder and instead the SNS is primarily switched on leading to hyper arousal, panic, worry, and other debilitating symptoms. Hypo arousal is also possible if the dorsal vagal state is default. One who has learned to “freeze” during times of high anxiety will find themselves in a more of a shutdown state.
Anxiety disorder is due to a system that had to remain hyper vigilant of threats in the environment. Untreated anxiety issues in childhood is linked to adult mental health issues. You can read more about that here. Trauma in childhood can be any threat the system found too overwhelming to process such as medical trauma, sexual abuse, physical abuse, bullying, accidents and more. Dr. Peter Levine identifies trauma as “not what happens to us, but what we hold inside in the absence of an empathetic witness.” So, it is not the experience but how the body reacts to it that would classify it as trauma. You can read more about Dr Levine here.
Until the system is able to access the social engagement state (ventral vagal) and finish the stress cycle it is in, the person will continue to feel the symptoms of anxiety.
In order to heal a dysregulated system and dysfunctional patterns of behavior one would have start by calming down the system. Practices and therapies found throughout this blog such as somatic experiencing, TRE, brain retraining , even EMDR, could be helpful. In a more regulated state the patterns of behavior that were at one time useful may not be as appealing. For example, a person with BPD who is breaking up with a partner may not find it useful any longer to engage in harmful , impulsive behaviors to try to get the person to stay, since they would be approaching the situation from a more regulated and thoughtful state. Calmness leads to more thoughtful decision making.
I encourage anyone who is suffering from a mental health issue to find a practitioner to help guide you and alleviate symptoms. There is a way out of suffering and onto a more meaningful path.
