How shame makes us sick

The damage done by fight or flight

Here’s what I’ve learned about trauma, and which I now know could also be true of shame. If we become trapped in a life in which our bodies regularly enter fight-or-flight mode – the parasympathetic nervous system raging, the non-essential muscles freezing, the blood being pumped to the legs and arms – it can do long-term damage to some of our most vital biological systems.

This is because when our bodies enter this state of shame or post-traumatic stress – or both – it suspends all functions it doesn’t consider necessary for escape. All our major organs, apart from the muscles needed to carry us away, simply shut down until the panic has passed. Our kidneys, our liver, our digestive system, they all stand still. Frozen. Fragmented.

This is incredibly helpful in moments of mortal danger. But when it is triggered by shame or by pieces of a traumatic memory on a daily or near-daily basis, it starts to have devastating effects on the way the body functions.

All this stopping and starting slows down the organs and the nervous system, and impedes our biological ability to respond to our needs appropriately. Instead of running smoothly, these vital systems become spluttering car engines, revving up and shutting down, only to try and get into gear again. It’s exhausting.

Untreated trauma and physical pain

When I was 17, about 18 months after the assault, I went on holiday with friends after finishing A levels. All of a sudden I got a sharp pain in my stomach that was somehow deep but stabbing at the same time. It was like knives through muscle, I remember thinking. I keeled over.

I ignored the pain for as long as I could, but within a few days I was in A&E at my local hospital, howling, begging for relief.

This was the first of many, many times this would happen. I was in and out of hospital for all of 2010, not able to cope with the debilitating pain in my abdomen or to find any answers as to what could be causing it. The doctors did blood tests and pregnancy tests and urine tests and they kept telling me I was fine. But I wasn’t.

Over the next few years I got sicker and sicker. The abdominal pain worsened and began to be accompanied by muscle aches, joint pain, fatigue and blurred vision.

Eventually I was diagnosed with extensive endometriosis – a disease where cells from the uterus grow and spread in other parts of the abdomen where they do not belong, and cause bleeding and pain.

Endometriosis is under-researched and woefully misunderstood. It causes women debilitating pain and affects around one in ten individuals with female reproductive organs. That’s the same as diabetes, but it gets only a fraction of the funding. On average, it takes seven to ten years to diagnose.

Because endometriosis is essentially a malfunctioning of the autoimmune system – cells spreading to inappropriate places and growing, then being attacked by an overactive immune system and causing more pain, more bleeding, more abnormal cell growth – it is now one of the conditions that doctors believe can be caused by untreated trauma.

The body keeps the score

In 2015, as the pain was worsening again, I was diagnosed with Crohn’s disease. Crohn’s is another autoimmune condition, primarily affecting the bowel. Experts think that it, too, can be caused by the long-term damage done to the digestive system by living in a near-constant state of post-traumatic stress. Doctors also believe that untreated trauma can lead to multiple sclerosis, fibromyalgia and some cancers.

If a traumatised person is treated immediately, for example after a car accident, the body can learn to re-regulate itself and not flare up into post-traumatic stress symptoms each time we are reminded of the incident. But if we leave our fear untreated, the damage it does to our bodies can be permanent.

If I had asked for help when I was raped, if I hadn’t said nothing for ten years, I might not now be living with two dynamic disabilities. The thing that made me sick, after all, wasn’t the attack alone. It was the thing that was doled out alongside it: shame.

I thought I could keep running from my attacker forever. From the memory, from the nightmares of him. I was wrong. As the trauma psychiatrist Bessel van der Kolk says, “the body keeps the score”.

Now I know there is a way out. If I can process my shame, if I can speak about it and exorcise it, I will eventually recover parts of the girl I used to be. That knowledge is unbelievably empowering.