Here is the full transcript of physiatrist John Rigg’s TEDx Talk: The Effect of Trauma on the Brain and How It Affects Behaviors at TEDxAugusta conference. This event took place on January 30, 2015. Dr. John Rigg is the director of the Traumatic Brain Injury Clinic at Fort Gordon.
Listen to the MP3 Audio: The effect of trauma on the brain and how it affects behaviors by John Rigg at TEDxAugusta
TRANSCRIPT:
I want to ask you to think back to some occasion in your life when you might have gotten in an argument with someone, particularly someone that you loved, you cared for a lot — a family member, a spouse, a parent and really reacted — really reacted, you got so angry, did things, you said things, maybe broke stuff, said hurtful things and then later on reflected on your behavior and wondering what happened: where did that come from?
I want to look at some of the factors that contribute to that type of overreaction, that mechanism, that hyper arousal that occurs. Hyper arousal, anger, hostility — where does that come from? What generates it?
I’m going to talk about stress, OK. Stress as a factor that can influence behaviors and look at the anatomy of the human brain — we actually have two brains that are contributing to our behaviors. Two brains contributing to our behaviors. And stress is particularly influential on one of them.
Stress is nothing that we think about, right? We don’t come up with stress. It is a reaction to the external environment. So let me talk about the two brains.
I have a diagram here of the cortex of the brain and this structure underneath the cortex of the brain, which is labeled brainstem in here. But I’m really going to talk about the subcortical brain, this entire structure here.
The cortex of the brain is what I’m going to call the human brain, the intelligent brain. It’s where our personality is, our individuality, where we make choices of our mate, what we eat, what kind of music we listen to, what car we drive, where we live, what type of life we live. We take in sensory information and it’s processed in the cortex, and we take actions based on sensory information. That’s where our personality, our individuality, is all centered in that cortical area.
Note in the human brain, it’s actually — by far the largest mass of the human brain is cortex, OK. We rule the world as humans. Why? Not because we perform animal functions better than any animals; we’re not bigger faster stronger than animals. We think better. We have the largest cortex and we rule the world.
But we’re animals. We eat, make waste products and make babies, and that behavior triggered by our primitive animal brain is sometimes responsible for triggering some of the behaviors that we’re not particularly fond of.
So this primitive animal brain, what does it do? Well, the brain reacts to situations whether we want it to or not. Particularly this animal brain which doesn’t think, it just reacts to the environment. So if I said to you, hey let’s all go outside and race across broad street but don’t your heartbeat increase; could you do it? No.
You can think to yourself, hey I’m going to stop my heartbeat for 10 seconds but you can’t do it. The thought exists, the thinking exists in the cortex, the human brain but the animal brain is controlling your heartbeat and won’t let you do it. So you can think all you want about lowering your blood pressure and it won’t happen. That primitive animal brain is maintaining your heartbeat, your breathing, your digestion from the moment that you’re born, I mean even pre-birth as a fetus, that these structures start operating in that central nervous system, primitive animal brain is operating non-stop until your death. Pretty amazing, OK.
I’m going to ask you to look at another way that this primitive animal brain reacts to situations, OK. So let’s picture a bunch of guys hanging out arguing about who’s going to win the Super Bowl, on Sunday talking about cars, whatever men might want to talk about when they’re involved in a conversation. I’m a man, so I look at — you know I only have a male perspective on things. But what you guys are sitting around talking.
And all of a sudden during that conversation, this really attractive looking woman walks by with an inappropriately short miniskirt and an inappropriately tight T-shirt, what’s going to happen to that conversation? The little Snickers in the audience, not me, man, I don’t look. Men will be attracted to that, not because they’re out there searching for mates, married men might react that way, OK, but because of the fact there’s an animal instinct of sexual attraction.
Why do advertisers put sexually attractive women in ads? To attract attention to that ad, so people go on buy stuff they don’t need, OK. It’s an animal instinct.
Now I may be distracted at times but I’m married. So I don’t go out and chase the girl. Married men, committed men in relationships might be attracted, might be like a magnetic boom but back focus on hey I’m married. I think the Patriots are going to lose or whatever, you know whatever the conversation is.
But the reaction and I don’t know how women react to men. I mean, fortunately you do react those ugly guys but it’s good. But that primitive sexual instinct is a really important behavioral driver on a day to day basis. Male elephants are attracted to female elephants. Female frogs mate with male frogs. All species, mates, sexual attractions, basic animal instinct.
A more powerful animal instinct programmed in that primitive animal brain is survival. And how do animals survive? Fight or flight, OK, much more powerful instinct.
So the primitive animal brain – to review — runs our body, breathing, digestion, heartbeat, maintains blood pressure and this program for primitive animal instincts that all animals have: eating, sexual attractions, seeking safety and shelter and then that most powerful instinct survival: fight-or-flight.
The cortex of the brain is our thinking brain, it makes decisions, it takes actions at those things, OK, based on sensory information.
It thinks, that’s where our memory is located, all of our processing.
Now my job on a daily basis is, I’m a physician, I work — I’m the director of the Traumatic Brain Injury for the military down here at Fort Gordon, Eisenhower Army Medical Center. And I’m going to use some examples of what happens to soldiers when they’re taken from the United States sent over to Iraq and Afghanistan and experience the traumatic experience of war and how does that experience impact their performance, how does that experience impact their behaviors based on the influence that traumatic experience has on their brain whether they wanted to or not, OK.
So what they do is they go to a place like Iraq or Afghanistan. What is the enemy trying to do to them when they’re there? Kill them. The enemy is trying to kill these men and women. So their fight-or-flight, their primitive animal instinct is ramped up and magnified, turn on big time, all the time not for like 20 minutes here and 10 minutes here but non-stop for 24×7 through their entire time of deployment. I was with the patient this morning, seven deployments — seven deployments, 14 months minimum in those seven deployments. Hyperactivated fight-or-flight.
And when you’re in a place where bad guys are trying to kill you, having your fight-or-flight activated to respond real quickly is the best thing that could happen to you. And it functions great when you’re in a combat zone.
But now let’s take that soldier and return him to the United States. You get on a plane, come back to the U.S., get off the plane, haaaa, I’m back home. What part of the brain is recognizing the geographic shift back to the United States? The cortex, the intelligent human thinking brain. But where was this hyper aroused fighter flight located? In the primitive animal brain, the subcortical brain, specifically a structure called the amygdala which becomes hyper activated and triggers fight-or-flight.
Now that was very very powerful and essential in a combat zone but the soldier now comes home and he’s still hyperactivated. So to give you an example I had one of my men went to – he was home for a few months, he was feeling pretty good, he went to a rock and roll show in Atlanta, hanging out in Atlanta, the concert, was doing OK with the crowds. But all of a sudden, boom, fireworks go off and bam he dives to the ground. Now he didn’t hear the explosion go, that sounds like a bomb, I’d better duck, OK. He reacted non-thinking.
So now let’s look at the anatomy of the brain because there’s one more super important point to make in here that’s fascinating. Sensory information comes in — we see, hear, taste, touch and smell, that sensor information comes into our sense organs, is sent to a structure in the brain except for smell, which bypasses the thalamus but all the rest are sent to the thalamus which is a relay station and it sends a signal to both the human intelligent cortical brain and the primitive animal brain.
So in this case of this explosion at a rock show, the explosion gets to the cortex and the cortex is going to think about it, umm, the explosion sounds like a bomb, wait, I’m in Atlanta. Oh my god, it’s a terrorist bomb. Wait, the band is still playing numbers, running for cover, nobody, there is fireworks, I’m OK. And the cortex could figure that out very quickly.
Simultaneously, that signal went to the animal brain. And the animal brain doesn’t understand geography. It’s hyper activated, it’s hyper activated particularly to explosions which in war meant what, IEDs, rocket-propelled grenades, mortars, blood, guts, death, body parts.
Here’s the second key point about this primitive animal brain. Number one, it doesn’t understand geography. Number two, it’s faster than the thinking brain. The animal brain actually is physiologically wired to respond faster than the thinking brain. So before the soldier can think, that explosion was fireworks, boom, he’s on the ground diving for cover. By the time he hits the ground he’s going oh my god I feel like a jerk down here. Because everybody else is up cheering and he’s on the ground, OK but it was a non-thinking response.
Non-thinking response is triggered by the animal brain which is wired to respond faster. When you think about it from a survival perspective, a survival perspective, the faster we react the more likely you ought to survive. So indeed through an evolutionary period — the human species has been around about 300,000 years but for 300 million years animals have had a fight-or-flight reaction. I don’t know who figures this stuff out, but it says in the biological books. 300 million years of fight-or-flight — the faster they react the more likely they are to survive.
The animal brain is not very smart, it’s fast; it’s fast. More of the quicker you respond to dangerous threatening situations the more likely you’re to survive. A child that grows up in an abused environment you could take them out of that home and put them somewhere else, but if he or she has experienced significant abuse in that home, that abuse has impacted their arousal system, their primitive animal brain, no matter how much in their cortical brain they may want to overcome that they are still reacting to situations programmed in that primitive animal brain which you can’t change by thinking, any more than you can change your heartbeat, your blood pressure, eat and hold your food your belly for four hours before you digest it.
So let me talk a little bit about irritability, OK. So there was a man and wife at home. And the wife asked her husband, “Honey, can you take out the trash for me?”
“Sure, baby, no problem. I’ll take out the garbage.”
So the man — he gets up, took out the garbage, did a good job, cleaned up everything, and nice, came back in the house, sat down, job done.
Now meanwhile his wife walked off into another room and had two little children — the two little children had spilled chocolate milk all over this beautiful brand-new white sofa. She was angry now, she’s got this new sofa with big nasty stains on it; she’s not happy. Why these kids spill chocolate milk in here, why did I get a white sofa, my relatives are coming to visit, I got this nasty stain on here, boy, is she angry. But she’s not mad at her husband, OK, but she comes back to her husband with a me-angry look on her face, OK. And now our husband is, in a maybe fatigued stressed-out with stuff going on at work or whatever, not particularly in a great mood. She comes back to him now and she got an angry look on her face and she goes, did you take out that trash like I asked you? He starts cursing at his wife and yelling at her. Wow, well what happened?
Well, how did she approach her husband? Aggressive, hostile, angry.
What’s the fastest part of the brain to respond to sensory information coming in as angry face and angry tone of voice? The fastest part of the brain that respond is what the primitive animal brain, in order for that man to recognize hey that’s my wife talking about the garbage, he needs his memory and his cortex to recognize his wife and to recognize the English language: did you take out the garbage?
So when he responded he didn’t respond to his wife, he responded to the aggressive tone of voice and the aggressive face that she presented. Now of course when he yells at his wife, she yelled like that, OK. So she barks at him and he barks back at her. And now they’re in a big argument over nonsense – over nonsense. Their intelligent thinking human brains made a decision hey I love you baby. Let’s get married and live happily ever after. Let’s have a wonderful life together. You’re awesome. Oh, yes you’re such a big strong man, you are going to be a wonderful husband and daddy.
But now in the heat of the moment that intelligent decision was gone. And the primitive animal brain has reacted and gotten him into a situation that their intelligent thinking brain never would have — never would have.
When the brain is hyper aroused, if it’s stressed out, certainly this is the situation that I see in military personnel who have been involved in combat but everybody gets stressed out: bills, family relations, neighbors making too much noise or whatever, OK. That hyper arousal, that primitive animal brain is pumping out stress hormones, interfering with sleep, keeping you up, OK. It can hijack memory because as you’re thinking of all the stress even unconsciously – if you remember I’m not talking about the conscious brain where you’re thinking and plotting and using your cortex. I am talking about hyper arousal, the animal brain that’s been stimulated by some type of stuff, okay, could be trauma, it could be just day-to-day stuff that’s accumulating and hard to manage. But the stress hormones get released, it activates that part of the brain and memory becomes difficult because concentration and attention — it’s not that the memory storage and recall is problematic, it’s just that the attention is being diverted to all this other stuff, OK, the stress factors.
For example, I’ll have a lot of soldiers who will tell me they have memory problems. I was talking to a guy once in my office and we started having a sports conversation and we get up and walking down the hall and I’m talking about the topic that we had been speaking about. We got to the end of the hall, he goes, doc, and I told you my memory sucks, I don’t remember anything you just said.
Well what happened was when I opened up the door we retraced our steps to analyze this. So when I opened up the door he saw other doors in the hallway and started thinking who’s in those rooms, what kind of weapons they got in there, whose footsteps are those coming on to the hall, one of the guys, a grenade what are we going to do. It’s about time we got to the end of the hall he wasn’t – he didn’t forget what I said, he never heard of it because his primitive animal brain was hyper aroused.
So what are you going to do about it? I mean as a neuroscientist, I went back to school later in life and became a physician and I have been fascinated being a brain mechanic that’s kind of what I consider myself to be. I’m not a behavioral health psychiatrist or anybody that deals with mood, depression and all this kind of stuff. But what I love is the way the brain operates as a machine, the most complex machine in the entire universe.
And what is really amazing to me is we got this part of the brain it’s reacting before we think and triggering hormonal releases and consequently behaviors that really take us in situations that we don’t necessarily want, when we look back well why did I do that.
During the day the brain is constantly generating ideas, constantly generating thoughts. It goes back to that — I like to think about in terms of ontology, Descartes 1650 said I think therefore I am. How did he define his being I think therefore I am.
Fast forward to the 1950s, French existentialist Jean-Paul Sartre was concerned not that I think therefore I am but I am the person that sees my thoughts. Thoughts may happen but they’re generated spontaneously by the brain. They’re not necessarily who you are, you are the person that sees those thoughts. I love that definition because that’s the cortex of the brain that I want to amplify, I want to magnify, when you use that cortex to determine in my life how I live my life what I do. I can see thoughts coming into my head, maybe getting emotional about stuff, angry about somebody challenging me or cutting me off on the road or something that’s challenging but it’s always good to stop for me, I stop to think wow, feel my reaction to it, is not necessarily what I want to happen here. What I want to happen I can control, I can do with my cortex, I still react because that primitive brain reacts.
So in my experience — I’ve been working for the Army for about almost seven years now, and a brain injury doc for a few years more than that, I see a lot of folks in this status who end up going to doctors and they get headache medications, prophylactic and a board of therapies. They get sleep meds which don’t work. They get mood medications, they get pain meds, OK.
Let me talk about one more thing I forgot. So stress, right? When you’re always walking around, all these muscles are tightening up, you’re walking around, neck is sore, back is sore, this is pain being generated by stress, with headache generation, particularly tension and then migraine headaches, neck muscles being tight from stress. Pretty much every soldier that I see that’s been to war has this going on.
So is the solution to give them headache meds to fix the headache or do we get to the cause of the problem? Let’s get to the cause of the problem, this isn’t rocket science, OK. A person’s stressed, it changes the way their body is operating, because of these stress hormones being activated so we can do things to reduce the stress. You don’t need Zoloft. Well I mean I’m not talking about — psychiatric patients need medications but I’m talking about just cases where there’s a clear-cut cause of hyper arousal, hyper stress, okay, where these physical symptoms are being generated not by abnormalities in the brain but by a set of circumstances that is arousing the primitive animal brain to create stress hormones and activation of this thing we call stress.
So what we do when we treat the men and women have gone to war is try to get to a solution. So how do we treat headaches? Send them to a physical therapist, they learn a stretching program, they get devices, heating devices, massage devices to loosen up the muscles, lower the tension that’s triggering the headaches, learn sleep hygiene, learn relaxation techniques. We have yoga classes. We teach meditation. Meditation has been an amazing tool. Meditation relaxes the brain. What happens — physical symptoms get better, headaches memory sleep mood issues all are improving.
Exercise — physical exercise is one I’m probably the biggest advocate of. We have many patients who are on profiles, meaning they are not allowed to exercise at normal high level of military. So we use these programs to really help the soldiers decrease their stress level and go to an organic holistic solution rather than using the pharmaceutical products which of course have significant side effects.
So I’ll leave you with the message of considering in your own lives how your primitive animal brain reacts to situations triggering actions and urge you to consider alternatives to the pharmaceutical industry.
I am about to demonstrate something that I do for relaxation. Before I was a physician, I was a professional guitar player for many years and I’m about to plug in this beautiful Gibson Les Paul over here and do a little — I’m going to do this as a tribute to the men and women that have served in military. I’ve had an amazing opportunity in my life to not only be a professional musician but to go to medical school and become a doctor in my 40s, because I live in this amazing country called the United States and I play this for all the veterans and current active-duty soldiers and people involved in the military who have allowed me to have the freedom to live this crazy life that I’ve had. So thank you and this is going to be for you.
[Music]
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