Trauma Without Memory?

My therapist and I have talked a lot about trauma. In and out of that context, I’ve referenced it here and written about it elsewhere—the idea being that a lot of being actually-autistic in the world seems analogous to the way in which people relate trauma.

I’ve talked before about how the inhibited habituation within the autistic brain raises the possibility that things that to the allistic world are “objectively” not traumatic might in fact be experienced traumatically by autistics. One thing I’ve gotten stuck on, though, is that much of how trauma is discussed involves memory and the re-experience of memory, and I’ve wondered, then, how trauma could get laid down in the brain of an autistic person who also has identified themselves as having Severely-Deficient Autobiographical Memory.

To wit: if my memories record the events of my life but not the lived experience of those memories, how can any experiences in my life be traumatic in the sense of causing me impairment beyond the instance of living those experiences at the time that they happened?

As often happens incidentally just from the sheer amount of stuff that I read in any given day or week, I ran into an article about something else altogether that maybe starts to give me an answer to that.

One way stress does this is by triggering the release of hormones called glucocorticoids, most notably cortisol. In small doses, glucocorticoids help the brain and body respond to a stressor (think: fight or flight) by changing heart rate, respiration, inflammation, and more to increase one’s odds of survival. Once the stressor is gone, the hormone levels recede. With chronic stress, however, the stressor never goes away, and the brain remains flooded with the chemicals. In the long term, elevated levels of glucocorticoids can cause changes that may lead to depression, anxiety, forgetfulness, and inattention.

[…]

Chronic stress can also alter the prefrontal cortex, the brain’s executive control center, and the amygdala, the fear and anxiety hub. Too many glucocorticoids for too long can impair the connections both within the prefrontal cortex and between it and the amygdala. As a result, the prefrontal cortex loses its ability to control the amygdala, leaving the fear and anxiety center to run unchecked. This pattern of brain activity (too much action in the amygdala and not enough communication with the prefrontal cortex) is common in people who have post-traumatic stress disorder (PTSD), another condition that spiked during the pandemic, particularly among frontline health-care workers.

I feel like somewhere out there, inevitably, are articles and papers about the ways in which memories are laid down in the brain as compared to the ways in which stress is laid down in the brain. I would like to find them.

Being actually-autistic in many ways is a kind of chronic stress, but, as I said, my lived experience is not re-experienced in the way we seemingly consider it to be necessary to discuss trauma. My subjective reality, though, to take one example, is that while I do not re-experience my vocational rehabilitation job placement, thinking about it, or thinking about returning to work at all, does conjure up into the present my fight, flight, or flee response.

During my first stab at a disability claim, in the wake of that debilitating job placement, the psychologist they sent me to for the consultive exam reaffirmed my autism diagnosis but also diagnosed me as having Adjustment Disorder (with anxiety and depressed mood). While more recent discussions of Adjustment Disorder have begun to incorporate a chronic version of the disorder, it’s mostly talked about in terms of a specific stressor, and usually contextualized around an idea of contemporaneousness, or at least a kind of temporal adjacency.

That job placement was in late 2017 and early 2018, and while one could make a case for a case of chronic Adjustment Disorder, the fact that my therapist and I keep having very interesting and fairly productive conversations about trauma, specifically, raises the argument of a refocusing—be it considered Post-Traumatic Stress Disorder itself or (because PTSD in the DSM-V emphasizes mortal or existential threats) so-called “subclinical” alternatives such as Other Specified Trauma- and Stressor-Related Disorder.

It’s an open question, beyond even that, what that means for treatment, per se. As referenced above, there’s some evidence that autistic brains simply don’t “do” habituation and often the focus of the treatment of trauma is exposure therapy which depends upon habituation.

What a refocus onto trauma would accomplish, however, is an increasingly accurate way to discuss and describe what living my life feels like—by which I mean not only to myself, or in therapy, but in my interfacing with the outside allistic and neurotypical world around me.

Too many people still don’t have much of a handle on what it means to be autistic, but I think it’s fair to say that a lot of people have some understanding of trauma. I’d like to think that offers something of an opportunity for a closer reading of the my autistic experience by those around me.