It is true they (saints) form a minority. More than that, they always will remain a minority. And yet I see therein the very challenge to join the minority. For the world is in a bad state, but everything will become still worse unless each of us does his best. – Viktor Frankl, Man’s Search for Meaning, 1959, p. 154
The visual is from the dryest place on earth, the Atacama Desert in Chile.
From Linda M. Rio – mental and emotional health author and PWN contributor – Viktor Frankl was a famed psychiatrist but also a Holocaust survivor who wrote about his own personal horrific life experiences in a way that gave others an insight not only into terror, but also resilience, triumph, and hope. Viktor Frankl’s, Man’s Search for Meaning, has sold more than 16 million copies in 50 languages and considered one of the most influential books of the 20th century. His writings inspired millions to acknowledge not only the existence of tremendous pain in the world but the challenge to make use of this in a transformative manner to find meaning to one’s life in spite of such suffering. Trauma is not exclusive to any country, era, gender, age as anyone, anytime can be impacted by a major life event. The importance of understanding the role intense stress or trauma has on the body, the pituitary gland in particular, will be briefly addressed here along with the equally important focus on recovery of the physical as well as emotional sequelae.
In recent decades volumes have been written and research done on trying to understand the impact extraordinarily negative life events have on the body, mind, spirit of those impacted. Pituitary World News has contributed to this topic in a June, 2021 article: https://pituitaryworldnews.org/its-time-to-talk-about-trauma/. This current article will continue this topic because it does relate specifically to those with neuroendocrine disorders, but also most humans to one degree or another. Unfortunately, our modern world has allowed almost immediate access to witness the moment many traumatic events occur. The unfortunate effect of an information age is that this also informs everyone of all ages of the many horrible things that can happen in the world. There was a time in the past when people could remain naïve to the horrors of life but nowadays it is difficult to avoid such awareness. There are certainly positives associated with knowing more but there is also a cost in the loss of a sense of safety, and having some level of safety is important for physical and mental repair and health.
In recent decades much medical and mental health research has made strides in understanding not only the impact traumatic events have on the mind, but also the body, as well as how people can recover from seemingly unrecoverable events. Perhaps even more important will be the question of how, like Dr. Frankl wrote, anyone who has suffered the unimaginable, can search and find their own life’s meaning in spite of the impact on the mind, body, soul.
By now many are aware of the Adverse Childhood Experiences (ACE) study which was originally conducted by Kaiser Permanente from 1995 to 1997 with two waves of data collection that included over 17,000 questionnaires completed. The ACE score is the total sum of different categories of what is termed adverse life events reported by the participants. The study’s findings show a relationship between the number of ACEs and negative health and well-being outcomes. What this means is as the number of ACEs a person experiences rises so does the risk for negative outcomes. What are considered adverse life events? According to the study such events as: experiencing violence, abuse, or neglect; witnessing violence in the home or community; having a family member attempt or die by suicide are examples of what would be considered an adverse event. It is also important to note that not all negative life experiences can be described in a study and the impact of any life event is a very personal and unique thing since there are innumerable factors that are unique to any human’s response. Factors such as physiological susceptibility, for example, must be taken into account. A person who is already suffering from a physical illness or disability will likely have fewer emotional and physical resources available to help as resources for healing and recovery. These are examples factors that contribute to one’s ability to withstand events to a greater or lesser degree. Resiliency and resources which can aid in a response to trauma as well as the potential for healing will be addressed later. Generally speaking, an event or experience is considered to have a greater impact on a person’s well-being if it is human by design. What this means is that if a negative experience is caused by another person rather than something non-human seems to affect a person much more deeply. For example, a natural weather disaster like a hurricane or flood can impact a large group of people in a community and cause terrible hardship, even death. The COVID pandemic was a global event that had an effect to some degree on almost every person on the planet. But, two primary factors make such events typically less impactful or at least have an improved chance for recovery. Firstly, when a number of people are impacted there is an automatic community developed that in a strange way brings people together in their collective grief and fear (over lost things like houses or possessions as well as loss of lives), and this collective binding can for many provide strength to get through not only the immediacy of the tragedy but also a pathway forward toward healing. In the early phase of COVID lockdowns people were kept isolated from one another which typically could contribute to negative mental health. However, even after one of the most pervasive and restrictive interventions ever imposed on human beings – the average impact is small or non-significant (note, this study did not address the impact of the lockdowns during the pandemic on children or adolescents) (depending on the type of outcome), suggesting that most people retain their capacity for psychological resilience (Prati and Mancini, 2021). These examples can now be opposed to a much more personal type of trauma. Physical, emotional, sexual abuses are extremely personal and often committed by someone who is supposed to be in the role of a caretaker, someone “safe”. This is especially true for abuses experienced by children since they are by nature the most vulnerable and in need of protection by those designated by society to care for them. When this expected position of trust is violated, especially by a person in a close, intimate relationship such as a parent or family member to the child, then the emotional and psychological devastation is likely to have a greater impact. One other important factor must be taken into account when looking at the impact of trauma on the mind, body, spirit. This factor is silence. If a terrible event occurs but the child, teen, adult feels fully and completely able to share the event, what happened, what they remember, especially if this sharing can be done as soon after the event as possible, then this allows for the healing process to begin immediately. Talking about a bad thing does help to release the negative energy associated with that thing. However, the reverse is also true in that the holding inside, inability to describe in great detail what happened and what it felt like does cause that thing to metaphorically grow into a psychological monster. The longer one keeps “the secret” the bigger and worse it gets. It is important to note that the telling, the describing of a negative, traumatic occurrence cannot be forced or pressured as the person must be able to unfold their own description within their own time and space. More harm than good can come from pushing someone to talk when they are not ready.
Since the development of the ACE questionnaire, more tools with greater specificity and validity have been developed to hopefully detect earlier the impact of negative life events such as those mentioned above and then to point folks in the direction of treatments that can help minimize the impact on the mind and body. The Hypothalamic Pituitary Adrenal Axis (HPA), along with the Limbic System in the brain are designed to help humans deal with stress, at least a reasonable amount of stress that is relatively short in duration therefore easily expended by taking action to deal with it. Normal amounts of stress are not typically problematic. It is the out-of-the-ordinary things that happen that cause a system to overload.
It is important to understand the difference between a traumatic event that occurs to an adult versus to a child. Humans have what is called the Stress Response System to help respond to a threat. This system promotes hyperarousal of necessary bodily changes that result in a fight, flight, or freeze response. In adults this is quite adaptive because, presumably, adults have choices about how to escape danger. Children, however, most often cannot escape on their own. Instead, the primary purpose for this response in children is the attract a primary caregiver who can protect or remove them from the situation (Murphy et al., 2022). Since there are highly complex physiological interactions that occur current researchers do disagree on which brain areas to be included in understanding not only the initial response to stress/trauma, but the long- term changes that may result. Most trauma researchers do, however, agree that three major circuits are involved: the HPA Axis, the limbic system, and the prefrontal cortex. Corticotropin Releasing Hormone (CRH) by the hypothalamus induces the brain to become alert. CRH then prompts the release of adrenal cortisol and cortisone. A series of additional responses trigger the body to react to a threat. When a stressor or threat is occasional this system works quite well. However, when there are severe and/or chronic threats, and if this occurs during the tender growth and development period of childhood the effects on the mind and body can be profound. There is some evidence that some pituitary and other neuroendocrine disorders have a connection to environmental factors. Portuguese researcher and endocrinologist, Luis G. Sobrinho, MD., suspected this association so conducted a study over a two-year period of time of patients diagnosed with hyperprolactinemia. A year of bi-monthly interviews were conducted leading to a pattern of menstrual irregularities developing in the patients shortly after an important life event, and a childhood history without a father or with a violent, often alcoholic father in those with the diagnosis versus the study’s control group. Conclusions of this study revealed that their observations, “support the formulation that paternal deprivation predisposes and important number of women to develop higher than average prolactin levels…a minority may proceed to develop a clinically relevant prolactinoma (Sobrinho et al., 1991). These observations raised the hypothesis that environmental factors preceded the development of the medical disorders and therefore the evidence suggests a causally related genesis of pathological hyperprolactinemia (Sobrinho, 2014).
There is also a major difference between a traumatic event that occurs once in a crisis situation versus something that is chronic in nature. The role of cortisol as part of the body’s stress response system is what helps mobilize energy necessary to fight, or flee (flight) from a danger. Cortisol has anti-inflammatory and anti-allergy properties. However, if cortisol is released persistently, as a child might experience in a domestic violent home, it can build up and become toxic to the hippocampus, cause protein breakdown and muscle wasting, even become an immunosuppressant to increase the risk of infections and medical illness (Anderson, F.G., 2021). Having low levels of cortisol at the time of a traumatic even has been shown to increase the risk of developing PTSD/posttraumatic stress disorder as well as in patients having suffered a TBI/traumatic brain injury (Sherin & Nemeroff, 2011).
Beyond Trauma: Building Resilience
From a Walsh, MSW, Ph.D., at the Mose and Sylvia Firestone Professor Emerita in the Crown Family School of Social Work, Policy, and Practice and the Department of Psychiatry, Pritzker School of Medicine, University of Chicago. is a highly esteemed scholar and foremost authority on family resilience in the face of all types of traumatic events. Dr. Walsh has written extensively on the impact of many forms of trauma and loss. Many patients with pituitary disorders describe themselves as having either lost a part of themselves or their former selves or feeling as if a part of them had died. The months, years, sometimes decades to first obtain a proper medical diagnosis, then undergo surgical and/or medical treatment, often leaves patients feeling like a major loss has occurred. This felt loss can be of youth lost, physical strength and stamina lost, mental capacity lost etc. But Dr. Walsh not only examines aspects of this kind of loss as possibly traumatic but emphasizes important factors that contribute to resiliency and healing even in the wake of such life events as any major medical condition. In her book, Complex and Traumatic Loss: Fostering Healing and Resilience(Walsh, 2023), she talks about “practicing the art of the possible” by focusing “efforts on what can be done, accepting what is beyond control and tolerating uncertainty” (p. 96). Finding ways to incorporate the experience of a neuroendocrine disorder into current life does not at all disavow the impact this may have on the patient, their family, and friends but allows for the possibility for hope.
Dr. Gabor Maté writes in his acclaimed book, The Myth of Normal, that often illnesses are thought of as something to battle. He disagrees with the common usage of the military metaphor of going into battle with an illness. The appeal of using terms like “battle” and “war” against such illnesses as cancer he says, “matches our feelings of anger and despair…We need to understand…there are things you can influence and things you can’t. It’s not a battle, it’s a push-pull phenomenon of finding balance and harmony, of kneading the conflicting forces into one dough” (p.87-88). But if using such terms and analogy as a battle or fight help a particular individual obtain the physical and emotional energy necessary to rally and face another day then that should be OK too. Each person must find whatever resources are helpful to them and not rely on any single source or person to define the path toward a better quality of life. Building resilience is an exercise not much difference than how physical endurance and strength are built with patience, time and persistence. For example, after a physical sports injury it takes time and practice to build strength back, sometimes the body never quite regains what was lost but certainly some degree of repair can happen with the right effort and guidance. A similar process occurs after an emotional and/or physical trauma. Complete healing never means that the trauma/injury is forgotten, just that with time, physical and psychological work, an improved quality life can be gained. The goal of emotional and physical resilience is never to completely go back to a prior state (as much as that may be desired) but to find ways to accept a new state which includes doing the necessary steps to have as good a life possible. Freedom from the weight that trauma can bring comes not from external factors but truly finding peace inside, enough peace to go on for another day, and another after that.
Anderson, F. (2021). Transcending trauma. PESI Publishing.
Kovler, J. and Prevedello, D. (2021). Trauma symptomatology in patients successfully treated for pituitary adenoma. Journal of the Endocrine Society, Volume 5, Issue Supplement_1, April-May 2021, Page A637, https://doi.org/10.1210/jendso/bvab048.1297
Maté, Gabor (2023). The myth of normal. New York: Avery.
Murphy, F., Nasa, A., Cullinane, D., Raajakesary, K., Gazzaz, A., Sooknarine, V. et al. (2022). Childhood trauma, the HPA Axis and psychiatric illnesses: a targeted literature synthesis. Child and Adolescent Psychiatry, 13, https://www.frontiersin.org/articles/10.3389/fpsyt.2022.748372/full
Prati G, Mancini AD. The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments. Psychol Med. 2021 Jan;51(2):201-211. Retrieved November 17, 2023 from doi: 10.1017/S0033291721000015. Epub 2021 Jan 13. PMID: 33436130; PMCID: PMC7844215.
Sherin, J.E., & Nemeroff, C.B. (2011). Post-traumatic stress disorder: The neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience, 1,3(3), 263-287.
Sobrinho, L. (1991). Neuropsychiatry of prolactin: causes and effects. Baillière Clinical Endocrinology and Metabolism, 5, 1, 119-142.
Sobrinho, L. (2014). Psychological factors and pituitary disease: the chicken and the egg. In L M.Rio (Ed.), The hormone factor in mental health: bridging the mind-body gap (pp. 105-118).
Van der Kolk, B. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. New York: Penguin Books.
Linda M. Rio, M.A., LMFT (805) 619-0950 www.Lindamrio.com
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