Many years ago, prior to making the decision to leave my doctoral program, I considered exploring the association between developmental trauma and neurodegenerative diseases (NDs) as my dissertation topic. While I would never go on to finish that degree, the curiosity remained, and I repeatedly observed this association ever since, both in and outside of the clinical setting. Recently, I decided to do a cursory review of the literature and discovered there have been others who took up similar investigative inquiry. Not surprisingly, many studies now show a strong association between childhood adversity and the development of such conditions, with one systematic review of the literature published in Frontiers in Aging Neuroscience in 2022 reporting: “All studies found Adverse Childhood Experiences (ACEs) were associated with an increased risk of Alzheimer’s Disease (AD).”[1]
A common hypothesis described in most studies I reviewed attribute this phenomenon to significant dysfunctional alterations to the major neuroendocrine system known as the hypothalamic-pituitary-adrenal axis (HPA axis), which elevates circulating corticosteroid levels (stress hormones)—a condition commonly found in those who suffered traumatic early-life adversities.[2] Studies have further concluded: “Stress experienced early in life induces structural, functional, and epigenetic changes in brain regions involved in cognition, predominantly in the frontal and temporal lobes and the hippocampus.”[3]
While many other associations have been made as potential causal links with NDs, including exposure of known neurotoxins like heavy metals, microplastics, and other highly inflammatory agents, including highly processed food substitutes, I have long suspected there may be another explanation for the association between ACEs and NDs, illuminated only at the periphery of the emerging research, though not specifically described. In addition to these other likely contributing factors, I suspect NDs may also develop as a form of psychological and emotional defense in both the victim and perpetrator populations where childhood abuse and/or neglect are concerned.
As I described in the two previous posts, “People Really Are Like Snowflakes…” and “…The Unrecognized Impact of Psychological Abuse & Neglect,” the physical and psychological needs of humans are nearly identical, as are the symptoms when deprivation occurs. And while many “experts” within the profession profess otherwise, where need deprivation has occurred, grief work (briefly described as the unrestricted physical processing of all emotional material related to significant losses in the presence of an understanding, caring, compassionate witness, who is fully capable of handling the intensity of such an experience while maintaining an attentive, grounded presence) is fundamental to the restoration of any healthy biological and psychological functioning. And while the body may be the sole harbinger of some memories (especially implicit memories—those memories associated with traumatic events occurring before around age two, when our conscious recall memory centers begin to come online), remembering—whether purely physical, mental, or both—is something I have found to be a non-negotiable aspect of such work, with the degree of recovery, healing, and growth realized from person to person proportional to the type and severity of the wounding, the timing, and the depth of the related work in response.
However, given the level of intense physical-emotional distress traumatic remembering evokes for victims (often bringing those who suffered at the extremes to believe they cannot survive it), forgetting is understandably desirable. For perpetrators of traumatic wounding, the intensity of the guilt, shame, regret, and fear of possibly not being able to change and/or having done irreparable damage to ones’ victims—especially for those who had the strong motivation and intention of not perpetuating any of the abuse or neglect they may have endured themselves as children—forgetting is also very attractive. And when working with many well-meaning parents and partners who begin to catch sight of the significant harms they caused, some degree of minimizing, blaming, or outright denial are almost always reflexively deployed in defense. At the farthest end of the denial continuum, there can be complete amnesia.
Of course, capacities for denial and/or dissociation are important and all-too-necessary psychological defenses children need when environmental stressors exceed their capacity to cope and they are absent a psychologically mature, knowledgeable, well-regulated adult who knows how to help them through highly charged physical-emotional states. However, from what I have observed, when these coping strategies are used well into adulthood—beyond the timeframe when they may be necessary and appropriate—it appears this tendency may also contribute to the development of NDs later in life.
Decades of close and careful observation further suggests that most people will have many opportunities (calls to remember) once they reach the physical state of adulthood, long before NDs or increased memory loss ever take hold, with many physical and mental health symptoms acting as signposts along the way. For example, many clients I have worked with have memory gaps or “holes” in their biographical memory, where there may be significant periods of their life that are inaccessible to them and there are no other known events or health conditions that could explain the gaps, such as a traumatic brain injury (TBI). Outside of a TBI, or the development of a diagnosed ND, memory gaps are a known trauma symptom. And while undesirable, symptoms like these can serve the important function of alerting the afflicted of the need to seek help exploring the potential of unmet needs and unresolved traumas from someone who can also help with learning how to process the difficult physical-emotional states that will likely accompany such work. Additionally, virtually every form of mental-illness, including symptoms of prolonged anxiety, depression, bi-polar, eating disorders, schizophrenia, and most others, can also serve as signposts, as nearly all cases of mental-illness have their roots in unmet needs and unresolved traumas as well. And finally, there are a host of psychosomatic symptoms and other physical disease manifestations, as described in a book I highly recommend, When the Body Says No, by Gabor Maté, MD, which expertly describes how these conditions may also serve as signposts for necessary changes and similar therapeutic work.[4]
Additionally, because NDs are typically diagnosed later in life, some have suggested that retirement and a lack of cognitive stimulation may also be to blame; however, hereto, I suspect a slightly different explanation. While the spirit continually seeks resolution of traumatic wounding—nudging us in that direction by way of the symptoms it creates—the mind finds the prospect so terribly unpleasant and dangerous, that once more, it understandably seeks to avoid it, and the ordinary distractions of modern life certainly help us in that regard. Today, almost every adult must find work or a career in order to meet other needs and given the amount of time and focus required by this activity, it can also serve as an effective distraction against traumatic remembering. In fact, this was mine for a long time, and it worked surprisingly well. So well in fact, that I thought all of my therapeutic work was completed long before I ever touched the really big stuff and the full depths of the grief work awaiting me. And it wasn’t until I reached a phase of complete physical burnout from years of intense workaholism that I found the most intense unresolved pain from my past waiting for me in that newly created space. Had I not found the courage to face what I had been running from for so long, and eventually someone capable of providing the help I needed to understand and navigate that most difficult territory, I don’t believe I would have survived to pen these words.
Beyond the focus and attention that work and career may require, people also begin seeing greater decline in their physical abilities in their retirement years, thereby losing the distracting ability even our physical activities may offer as well. As Alice Miller wrote in The Truth Will Set You Free, from her own clinical observations: “As our physical strength fades and we lose our youthful vigor, we are particularly susceptible to flashbacks to a time when we were helpless children.” Miller further argues—as do I—that for healing and recovery, “We need an open door to our own past, an opportunity to take its very beginning seriously.”[5] For so many, this phase of life appears to include the spirit’s final call to remember—to grieve—and to reconcile with what we lost or missed out on entirely in this life, and the subsequent harms we may have caused others (intended or not) in response to those traumatic events and unhealed wounds. Ignore this call once more at this phase in life, and the opportunity may finally foreclose for good. I have witnessed this phenomenon many times, not only in the clinic, but with some friends and members of my own family who carry significant unresolved trauma and continue to avoid seeing and accepting the full truth of their early life experiences and engaging in the corresponding grief work those experiences rightly call for.
So, it could be an ever-increasing toxin exposure in a highly polluted world, genetics, age, a lack of stimulus, or a host of other variables that best explains why we see an increase in the diagnosis of NDs, which develop more rapidly for the retired, aging populations, but it might also be the case that without the distractions afforded from earlier stages of life, NDs develop as a final form of unconscious psychological defense against the unwanted painful remembering that may fill the void when there is less room for distracting from the important and necessary spirit work required to heal from past wounding. All I know for sure is that I’ve seen this pattern enough times that it continues to motivate me in the direction toward truth, remembering, and the corresponding physical-emotional processing work, and this remains my recommendation for everyone, despite the excruciating difficulty it brings. Again, I could be wrong, but for the reasons I did my best to articulate here: our choices may really come down to this in many instances: 1) to remember, or 2) to forget. And if that’s the case, I have found no evidence that suggests we get a final vote in what we remember. Once more, as I argued in “Grief & Love: Why We Can’t Have One Without the Other,” the good and the bad appear to be a packaged deal, and a choice of significant consequence, with there being such a thing as “too late” when it comes to memory loss and onset of NDs.
[1] Corney, K. B., West, E. C., Quirk, S. E., Pasco, J. A., Stuart, A. L., Manavi, B. A., Kavanagh, B. E., & Williams, L. J. (2022). The relationship between adverse childhood experiences and alzheimer’s disease: A systematic review. Frontiers in Aging Neuroscience, 14. https://doi.org/10.3389/fnagi.2022.831378
[2] Justice, N. J. (2018). The relationship between stress and alzheimer’s disease. Neurobiology of Stress, 8, 127–133. https://doi.org/10.1016/j.ynstr.2018.04.002
[3] Burri, A., Maercker, A., Krammer, S., & Simmen-Janevska, K. (2013). Childhood trauma and PTSD symptoms increase the risk of cognitive impairment in a sample of former indentured child laborers in old age. PLoS ONE, 8(2). https://doi.org/10.1371/journal.pone.0057826
[4] Maté, G. (2011). When the Body Says No: Exploring the Stress-Disease Connection. Trade Paper Press.
[5] Miller, A. (2003a). The truth will set you free: Overcoming emotional blindness and finding your true adult self. Basic Books.