Does Stress Damage the Brain?

American Journal of Clinical Hypnosis,  Jan 2003  by Hunter, Marlene E

• E-mail
• Print
• Link

Does Stress Damage the Brain? J. Douglas Bremner. New York: W.W. Norton (2002) xii+311 pp., $30.00 (hardback). Reviewed by Marlene E. Hunter, MD, FCFP(C), Vancouver, BC.

Sometimes a book is at the same time so stimulating and so exasperating that you don't know whether to grit your teeth or shake your head in wonderment. Such a book was, for me, Bremner's Does Stress Damage the Brain?

The neurophysiology and research is wonderful. It validates what so many of us have been saying for a long time, about stress, trauma and Posttraumatic Stress Disorder, and it's always nice to be validated. The manner in which brain studies and clinical presentations are associated is excellent, and very useful. And Bremner's philosophy is very satisfying.

But (here it comes) the writing style is erratic and the editing, in my opinion, leaves a lot to be desired. After the first few pages of the introduction, I went back and verified that the word "absurd" had been used three times in sixteen consecutive lines. Throughout the book, I found myself reading two or three sentences, shaking my head, and going back to verify that the very same lines were there twenty pages before and fifty pages before that. For example, on page 146, lines 2-5 state "Other disorders that are increased following exposure to traumatic stress include anxiety disorders (panic disorder and generalized anxiety disorder), somatic disorders, dissociative disorders, and alcohol and substance abuse..." Lines 19 to 24 on the same page state "...physical disorders that are increased by traumatic events, including depression, alcohol and drug abuse, anxiety disorders, somatic disorders, and dissociative disorders..." This redundancy makes the reader wonder whether Bremner wrote book chapters as he had the time to do so and then put them together without enough thought for continuity. Where was his editor?

Bremner's work is full of mind-stretching, extremely sophisticated research, yet at times, it is as if the author is speaking to a high school class, while at other times, to a group of super-advanced neurophysiologists. As an example, on page 44 he writes, "This outer gray matter portion of the brain is called the cerebral cortex. Different parts of the cerebral cortex have different functions, for instance, the occipital cortex (in the back of the brain) is responsible for vision, while the motor cortex (on top of the brain) is responsible for movement." Page 133, on the other hand, has a graphic outline of the neural circuitry of PTSD describing the posterior cingulate, parietal and motor cortex and their relationship in visual processing and assessment of threat to the medial prefrontal cortex, thalamus, hippocampus and amygdala. The graph is full of arrows going both back and forth in seven directions and one way in three more. Of course, as one sits and studies it, it makes sense, but it is a far cry from the very basic descriptive language on page 44. To me, it is unclear whether the intended readership is the public, the clinician, or the neuroscientist. I think he has been hoping to reach all three-but with varying degrees of success.

On the very positive side, the book is crammed with fascinating information-- neurology, neurophysiology and neuroanatomy-to explain his basic thesis: The damage that stress, especially traumatic stress, does to the brain and the long lasting effects of that damage.

The book in divided into two main sections: Part I is "Mind and Brain from a Trauma-Centric Perspective" and Part II is "The Widening Influence of Trauma in the World Today." Chapter 4, "Effects of Stress on Memory and the Brain" attends to, amongst other things, delayed recall of memories of abuse, the malleability of memory, and the false memory debate. Of the latter, Bremner states: "My feeling is that there are a number of individuals who truly have been abused and who don't have clear memory of their abuse, and may have inserted false and distorted memories relating to their childhood, who nevertheless have PTSD symptoms related to actual traumatic events in childhood" (p. 104). I think that this is what many of us have been saying for a long time, and it is heartening to read it in a book by a man of Bremner's stature.

In Chapter VI, the author recounts a brief history of the classification of stressinduced disorders and describes the new concept that PTSD has two subtypes, one a hyperarousal/intrusive response and the other a dissociative response. The importance of this is that the two respond differently to interventions, with the dissociative type not doing well by being subjected to scripts of traumatic events which are meant to desensitize. He also comments that their research "surprisingly" suggests that emotional abuse and neglect may be as damaging as sexual abuse, though it is unclear why one would be surprised. He also does not include attachment disorders here, which disappointed me.

Chapter VII is one of my favorite chapters in the book, second only to Chapter VIII on treatments and how they may act through the brain. Chapter VII is titled "PTSD and Other Stress-Related Psychiatric Disorders as Diseases of the Brain Caused by Stress". Bremner strongly describes his belief, supporting it by all the neurological data at his disposal (which is impressive) that trauma creates brain damage which in turn causes the trauma-spectrum psychiatric disorders. His term "trauma-spectrum" demands that these disorders are seen to be related and must not be considered individually or as occurring independently of one another. The same effects on hippocampal functioning, memory dysregulation, and problems in the prefrontal areas which in turn affect emotions, are seen throughout this whole spectrum of trauma-- related illness.