In the current edition of Biological Psychiatry there are several articles that point out how an understanding of brain function derived from new techniques that allow us to see how the brain functions much more clearly and to identify changes in the structure and function of the brain that could not be detected before may change our response to human problems that society has denied existed.
Victorian era European societies had a very hard time understanding and accepting the experiences of women who developed dissociative symptoms as a result of childhood sexual trauma. Even the forward-looking psychoanalyst Freud could not believe that sexual trauma could be the cause of all of the patients he saw with dissociative symptoms. Freud simply couldn’t believe that sexual abuse could be so prevalent: “Surely such widespread perversions against children are not very probable” As a result he formulated a theory that asserted that hysterical symptoms were the result of repressed sexual fantasies rather than actual traumatic events.
Similar skepticism about the impact of discrimination on black Americans continues to shape how we think about the effects of racial discrimination. According to a recent Pew Research poll, even those who believe that black Americans face more barriers to success than white Americans, many feel that this is due to factors such as a lack of good role models and family instability. In other words, we find it hard to accept the notion that discrimination is as pervasive and as harmful as it would have to be to explain the huge differences in success among black Americans compared with white Americans.
In an “Clinical Commentary”, Lebois, Ross and Kaufman summarize research that identifies patterns of brain activity in the ventromedial prefrontal cortex and the amygdala that exist in those with PTSD who experience dissociative symptoms and that may also underlie the experiences of those who develop “complex PTSD.”
“After more than a century, science is finally catching up with the experiences of front-line clinicians. Janet’s original formulation was prescient. DID is, in fact, a complex, bio-psychosocial syndrome—an alternative neurodevelopmental pathway that can emerge with chronic childhood maltreatment. The core clinical feature is a disruption to the sense of self and mind. Under ordinary circumstances, children gradually coalesce a cohesive sense of self; however, in the context of trauma, individuals with the capacity to dissociate (perhaps based on genetic factors) can be left with discrete self-states that patients describe as feeling like they’re ‘not me’
Social scientists have long known that being black in America is associated with not just lower economic success but also poorer health status across many measures. What has not been clear is why this is the case. In a study of Black American women, Fani et al. found an association between racial discrimination and a change in white matter that was identified more than a decade ago as a manifestation of poorer executive functioning caused by brain aging (lower fractional anisotropy in white matter tracts). These findings remained after controlling for trauma exposure, posttraumatic stress disorder (PTSD), and demographic factors. This study helps us see one way that racial discrimination can lead to neuropsychiatric problems in Black Americans.
References
Fani N, Harnett NG, Bradley B, Mekawi Y, Powers A, Stevens JS, Ressler KJ, Carter SE. Racial Discrimination and White Matter Microstructure in Trauma-Exposed Black Women. Biol Psychiatry. 2022 Feb 1;91(3):254-261. doi: 10.1016/j.biopsych.2021.08.011. Epub 2021 Aug 24. PMID: 34776124; PMCID: PMC8714668.
Lebois LAM, Ross DA, Kaufman ML. “I Am Not I”: The Neuroscience of Dissociative Identity Disorder. Biol Psychiatry. 2022 Feb 1;91(3):e11-e13. doi: 10.1016/j.biopsych.2021.11.004. PMID: 34961597.
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