Interview with Dr. Aviva Romm
Part 2: Health Impacts of Trauma & Oppression
In preparation for the annual fall Southeast Wise Women Herbal Conference, Corinna Wood interviews Aviva Romm about her work with supporting women in "overcoming overwhelm" and getting out of S.O.S. (Survival Overdrive Syndrome), as well as some of the root causes of trauma and oppression that contribute to these health issues in the first place. Aviva Romm is a midwife, herbalist, and Yale-trained MD, bridging the best of traditional medicine with good science for over three decades.
Corinna: We know that many woman and girls today experience trauma, and you're bringing forward to the medical community a greater awareness of some of the health impacts of trauma and false beliefs which often arise out of adaptations to trauma. Can you speak to the links between trauma and SOS?
Aviva: Trauma is any set of circumstances that threaten our survival or cause us to feel threatened, cause us to feel our survival is at risk. That can be anything from overt physical abuse, assault, having been raised in a socioeconomically or racially impacted environment where your food, your shelter, your stability at home, love, belonging and safety were impacted. It could also be sort of indirect trauma. For example, being raised in a home with parents who were fighting all the time or an alcoholic parent who even if you weren't directly abused was abusive to the other parent, for example. There are lots of things that can cause us to experience trauma. Where we experience trauma in our brain is called the amygdala, and it's the part of our brain that picks up and stores any memories. Those can be scent, sight, sound, emotion, any triggers that are related to that trauma. That part of our brain along with another part of our brain called the hippocampus store and catalog all these memories.
What happens is that when you have the initial experience or continued experience of trauma, it activates the amygdala which sends chemical messengers to the hypothalamus which then relays that message to your pituitary gland and onto your adrenal glands, stimulating the production of adrenaline in your adrenal glands and also outside of your adrenal glands. Adrenaline thus is produced and released, and cortisol is produced and released. This is direct downstream effect of any kind of stressor that we experience that puts our primitive survival mode into activation to save us.
When that primitive survival response is kicked in, you go into one of three modes: fight, flight, or freeze. A lot of women who have experienced sexual trauma, for example, know that during the act of the sexual trauma while they are being acutely victimized, they go out of their body. They dissociate. That can be considered freezing. Your body freezes, your brain dissociates. It's a little bit like the deer in the headlight phenomena. Certain animals, when they sense danger, they freeze. The objective of this on an evolutionary scale is they become still and they hope that the predator doesn't see them, doesn't pick up their movement.
Some people are also primed to respond that way. We all have individual responses based probably on our innate self who we are and also on the circumstances in which we were raised or in which the trauma happened. Whatever reaction was the most safe for us, that's the one we tend to carry forward. For women who had dissociated in their lives, they may actually continue to do that same behavioral pattern any time they're stressed. They shut down, they go kind of catatonic. Not literally catatonic but they kind of check out and don't have a good ability to confront stress, and they tend to carry that victim role throughout their lives because they were victimized. That’s the way that they were able to be safe in that moment; the way they were able to integrate horrific trauma was to check out and not be present.
For some people, fear and threat trigger them to flee away from the danger. Maybe you had a violent home, and the only place to go was to run into the closet or run to the neighbor's house, or you had a situation where you did have to literally physically run away from danger. Those escape routes can be physical escape routes, or they can be escape routes of things that numb you out like drugs or alcohol or sex or TV or food or whatever it is.
Other people go into the fight mode. I'm one of those people. I grew up in a housing project, with kind of a scrappy personality. If I face danger or have a sense of danger, I tend to take it head on. I get angry. I have no problem cursing somebody out or protecting somebody else. It's not always a good thing because the problem with this trigger is that it's like a hair trigger response in that our brain and our body will do anything to protect our survival. If we're super primed because we've had trauma, this whole system can get activated at the drop of anything that whiffs of that original danger. For example, if you had a parent who was verbally or emotionally or physically abusive, and you started to recognize their facial expressions of when they were going to haul off and hit you or scream at you, you got very keyed into certain kinds of facial expressions.
Similarly, even as a young baby, if you had a mother who was depressed and had maybe postpartum depression, and your normal baby cooing and giggling didn't get her to make an appropriate response because her face was flat because she was depressed, you register depression as lack of love and lack of safety and lack of response. Similarly, if you were in the abusive home, you recognized certain facial expressions as, "I'd better duck, run, get out of here or placate somebody or do something," in which case let's say you're that person and you're in a meeting with your boss, and your boss is thinking about something totally different but just happens to have facial expressions that remind you of that person who was a threat to you, your instincts internally may put you right into that moment. You're in that sense of fight or flight or freeze.
Similarly, if you have a spouse or a friend or you go to a job interview and someone has kind of a more flat facial affect because they're not a very effusive person, or maybe they are depressed, or maybe they just weren't paying attention so it didn't give you the response you were expecting. Then you might be more sensitized to that, and you might take it personally and think that you're being rejected. This has a huge impact on how we live our lives, the risk we take.
Interestingly also, if you've had trauma, your HPA axis, this hypothalamic-pituitary-adrenal axis, particularly if you had trauma at a young age, is at a lower set point, so more things are likely to trigger you than the next person who didn't have that trauma, who had more of a safe, secure upbringing. Interestingly, your brain goes into something called negativity bias.
In order to protect ourselves, our brains make us go into something called hyper-vigilance. That's when you're super alert and aware of your environment, and it happens in an acute stress. If you're in a parking garage alone, and you're a woman, and it's night, and you hear footsteps behind you, it's not like you're just going to start singing some song from "The Sound of Music." Your back's going to go up, your ears are going to get more sensitized to sound, you're going to start looking around, your heart rate's going to get faster, you're probably going to reach into your pocket or your bag for your keys if you don't have them out already, maybe you're grabbing your cell phone. You're stressed.
When you are primed to be in this SOS response, it's almost like your brain is always hyper-vigilant, and it's affecting your body because cortisol and adrenaline make all those things physically happen in your body. You become on the lookout for danger all the time or most of the time. You might be somebody who tends to think the worst is going to happen to you even when there's no evidence of that in your current life. You may think that other people are always talking about you or looking at you funny because they're making facial expressions that trigger you. You may think that you're never going to be successful or have love or get the job you want.
Your brain is literally primed to see the negative, for example to see the worst in other people. Your judgment factor is acute; its amplitude is turned up to keep you safe. We can be living out all these patterns in our adult lives that as women can significantly hold us back and affect our careers, our relationships, our economic security, our family members because we're living from this old mode. One of the things that I teach about increasingly, not just using herbal work and nutrition and connecting people to nature but just really connecting ourselves to the importance of rewiring some of these old neural pathways that get us stuck in these behaviors.
Corinna: How do you see endemic sexism of modern culture - and racism for women of color - contributing to stress levels and SOS for women today?
Aviva: That's such a big question. I can speak for myself based on socioeconomics and also being a woman. While I can also speak to the racism that is impacting women’s health from a statistical and human perspective, I cannot, and would not ever assume to speak to the experience of being a woman of color. That would inappropriate. My job is to listen and understand, and call out racism in any way I can. But I'm a Caucasian woman and though I grew up in a housing project in New York City with a single mom in the 1970s, the additional stress on women of color is incomparable.
There are so many ways that sexism and SOS challenges impact our stress response. Speaking for myself, and this is a big impetus for me in the book that I wrote, was coming up in an environment where you always kind of wonder what was coming next. Was there violence? Was there going to be enough food? At one point in my middle school years I went to a private school for a couple of years. I got a scholarship, and it was like, what are the other kids going to be wearing that I can't wear? It really can set up a very lower threshold for activation of your stress response.
It's interesting because you can become more triggered by more things in some ways because the threshold for activation is lower. On the other hand, there are some inherent powerful skills that can come from those experiences in that you become keenly aware of other people's facial expressions, of danger around you. You can become super primed to be intuitive about people. You can have a hell of a lot of effing grit. I am a hard worker partly because from a young age I was like, "I'm going to get the fuck out of this environment," basically, "And I'm never coming back." I worked really hard to do well in school.
I left home at 15. I had already gotten accepted to college at 14, but then again, some of those internal drives that were driven by that stress response were very entrenched in me, and I write about this in the book and increasingly sharing about it more and more because I think it's so important in that for me, I learned really early that if I please people, if I please my teachers, if I work my ass off all the time and I do really well on this and I do really well on that, then I am safe in my environment, and I get rewarded for it, and I get promoted for it.
At some point if you don't learn that you don't need to be stuck in that mode anymore, it can start to take on a life of its own, and you can start to feel like, "I can never shut it off. I always have to please people. I always have to take on the next opportunity and say yes." Learning to adjust, we develop these adaptive patterns, but at some point in our lives if we get out of that environment, they become maladaptive. Sometimes they can even become maladaptive to getting you out of the environment.
We see that with sexism, right? Look at all the ways that women have learned to play it safe. We stay small at meetings. We upend our senses. One of the reasons that I only allow women to take my training programs is not because I don't like men. I love men, but I notice that when even I have a powerful group of women in a room together or on a conference call together and a man is there, all of a sudden everybody's ending their statements with question marks and they're deferring to the man as the expert in the room. I'm like, "What the hell? This is ridiculous." We've done those things to play small and stay safe.
We do these things out of necessity, but I think that those patterns are maladaptive because by continuing to play small we stay small. Now, again, there are some skills that women have learned in terms of manipulating the situation, not in a manipulative way but in a way that allows us to be effective. Cheryl Sandburg, for example, talks about her advice for women on getting along at board meetings, focusing on some of the ways that we can respond. At a board meeting, for example, a woman might express an idea and nobody will hear her, and then the man sitting right next to her will repeat the same idea, having either consciously or subconsciously heard it from her, and everyone will be like, "That was a great idea." We need to develop ways that we, as women, can use our voices and speak up and be heard. This is so important because if we don't, then everything our daughters learn from us they're going to emulate parts of it. We need to teach a difference to create a difference for the next generation.
I could just go on and on about this. A big reason that I wrote my book for women - men have thyroid problems, men have autoimmune diseases, men struggle with overweight and depression and anxiety, but here's the thing: women are more likely to be underdiagnosed, misdiagnosed, completely unseen and unheard to the point that 5,000 more women die a year in the hospital of a heart attack than men in the hospital because when men report chest pain, they're more likely to get a cardiac workup. When women report chest pain, they're more likely to get an anxiety medication, a sleep medication or a pain medication. They're not going to get the cardiac workup.
On average, it takes about five years for a woman to find a doctor who will properly diagnose her for an autoimmune disease. That does not usually happen with men. On top of it, women are 8 to 1 times more likely to have an autoimmune disease than men. Eighty or ninety percent of all Hashimoto's in the United States is women. Five of the top surgeries done in the United States are done on women, and two of those hysterectomies and Cesarean sections are done unnecessarily more than half the time. Women are getting major abdominal surgery, and this is all sexism. We need to look at the confounding factors that impact women getting a diagnosis, getting treated properly, being seen and heard.
The combination of sexism and racism is a deadly combination. Look at the maternal mortality rates in this country; they are highest in the African American and Latina communities. Those are women that go unseen and unnoticed by the medical system. We look at things like forced sterilization of Latina and African American women - this was legal in California until the 1980s, just 30 years ago. I was already practicing as a midwife when that was still legal. We could have a whole conversation just on this, and it clearly gets me angry and fired up, but it's part of why I do what I do. It's mostly why I do what I do. It's got to change.
Women are made to connect. We have higher levels of oxytocin production, and we have higher levels of oxytocin receptors, and especially during our childbearing years those go up even more. We are socially primed to tend and befriend. That is a natural stress response for us, right? When we're stressed out, most of us don't think about going out and shooting deer. We think about calling our bestie. We think about calling our best girlfriend or our sister or mother or daughter. One of the huge impacts that is happening to women, and it's a sort of indirect result of sexism, is really a result of how we're wired and made and evolved and how that's incongruent with how our society is.
Yes, there's Facebook and yes, there's Twitter and all of that, but increasingly we're most isolated from each other. Interestingly, when you look at relational health, when we look at the health of what happens in a relationship, women physiologically take a bigger hit physically and emotionally and psychologically when there is disconnect in our relationships. When we are in a board meeting and we're experiencing sexism, when we are at the doctor's office and we're experiencing sexism or when we're experiencing it in a relationship, we actually have cortisol changes that have an impact on our health.
Even on the most simple level for example, women who are in relationships with men - it's only been studied in heterosexual couples to my knowledge – and who come home from work and tell their partner what a crappy day she had, his cortisol levels don't go up. When the male partner tells the woman if he had a crappy day, her cortisol levels go up. Women who sleep next to men that they're in unhappy relationships with, their cortisol goes up and their sleep is disrupted. This doesn't happen so much for men. Stress also has a bigger impact on us. We know that women experience at least 30 to 40% more physical health problems, headaches, digestive changes, anxiety, depression, sleep problems than men as a result of stress. Read Part 1.
Aviva Romm, MD
A midwife, herbalist, and Yale-trained MD, Board Certified in Family Medicine with Obstetrics, Dr. Romm has bridged the best of traditional medicine with good science for over three decades.
Founder and director of Southeast Wise Women and co-founder of Red Moon Herbs, Corinna has been practicing and sharing the Wise Woman Tradition of herbal medicine for over 25 years.