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Part Three: Trauma and Epigenetics
In an earlier commentary in this series, I touched on ideas about mental health care developed in Baghdad in the eighth century that treated patients with respect and dignity. In this installment, I’m going to elaborate a bit about mental health and trauma and how they are studied today, especially among refugees and ethnic populations.
I’ve been working in genetics of ethnic populations, and I’ve also come into the field of trauma because I’m a daughter of a refugee from Palestine, and because of the Syrian crisis that has prompted a flow of refugees into Jordan, where I live.
To me, the mantra is seeing what everybody sees but thinking what no one has thought. So I begin by asking, What is trauma? When you look at the standard definitions, they are usually about an acute event. But we know that trauma is not an acute event, it’s something you live with continuously, at least in the majority of people around the world. So we must ask, how do we deal with a continuum rather than an acute event? And how do you measure trauma?
Traditionally, measuring trauma has been done through surveys, but I question how accurate they are, when we know trauma has a complicated, complex impact on the body, and the way we respond is very complicated.
When traditional surveys talk about trauma, it’s in a negative way and this results in victimizing the person who has been exposed to trauma. Can we switch that? Can we take a positive framework to that? Can we think of the person who was exposed to trauma, or who is going through trauma continuously or experiencing the ramifications of that trauma, in a way that gives them dignity and respect?
The Positive Impact of Trauma
In other words, can we look at the positive impact of trauma?
I draw this idea from my understanding of the world from my religion as a Muslim. When I suggest it, I am confronted with, How can you celebrate trauma by saying it has a positive impact? My reply is, No, I’m not celebrating trauma, I’m a daughter of refugees, I know what happens. But a human being is a complicated organism, and throughout human history, we have been evolving and been exposed to different types of trauma. So in order to really understand it and to help improve how we deal with the impact of it, we need to consider not just the negative aspects of trauma but look at it through a positive lens.
This frame of reference led me to work on studying trauma through epigenetics. That means, What is the impact of trauma in the environment in general, and in particular on our bodies?
We know that the way we manifest our behaviour, which is our phenotype on the outside, is a combination of our genetics and the environment, and how that environment actually impacts our DNA. At the molecular level, DNA is actually wrapped around proteins, and if you wrap that DNA really tightly because of a process called methylation, a particular gene is turned off, but if you loosen it the gene is turned on. Many processes influence how tightly DNA is wrapped, but one of them is methylation and that is something that is impacted by the environment. So by exposure to trauma, a gene can be more or less tightly wound, and therefore turned on or off.
Throughout your lifetime because of exposure to different stimulants from the environment, your DNA doesn’t change as a sequence, but which genes are turned on and off can change. You can see this throughout a person’s life, as a zygote in the uterus of the mother, or later the child is born, and then as they grow older. This is what we call the epigenome, and what scientists are trying to do today is to understand the impact of the environment on the epigenome.
Epigenetics and the Biological Clock
In my case, what I study is what is the impact of trauma on the epigenome. We know there are many determinants for that, including your race and ethnicity and your social determinants of health, which include your parents, your income, your education level, where you live, etc., your practices and style of life. All of these factors impact which genes are turned on or off, and that affects you not just early in life, but through midlife and even late life. And again, all this has usually been taken in negative.
Recently, a paper came out talking about how we can look at the role of epigenetics in psychological resilience, how we can look at it from a positive framework and how, when we do that, we can look at an acceleration of the biological clock.
So we all have a biological clock that regulates our aging. If we adopt negative practices, like smoking, or are exposed to negative things like trauma, our biological clock is accelerated and if we adopt good practices, like good nutrition and exercising, and are surrounded by family and people, we can de-accelerate that aging.
So there’s a new biological clock for children that’s been developed by Michael Kobor, in Vancouver British Columbia. Kobor was able to show that just by taking a cheek swab, we can measure the biological age of a child’s DNA and determine how fast the child’s biological clock is moving. We can look at intrinsic factors as well as extrinsic factors the child is exposed to, and how they affect the child’s biological clock. What’s interesting to see is how this changes with time, and whether we can develop interventions to reverse the impact.
Studying Refugees, Preserving Dignity
This leads me to ask, How can we apply this knowledge with refugee populations, as I mentioned earlier, in a positive way to give them dignity?
We know the number of refugees is increasing all over the world, unfortunately, and we must always first talk about how do we stop the wars, because you stop the source where it is instead of just fixing things at the end of the river.
However, at the same time there are children today who are living with the consequences of war and other traumas they went through. How can we help these children to do better? How can we develop interventions that celebrate them and build their resilience?
Actually, that was one of the studies we did. The journal Science ran a special edition about resilience and how we can celebrate resilience and work on it, as a way to deal with trauma. We’ve developed a special resilience survey and we’re even looking at other methods.
As I have said, I am sceptical of traditional surveys for measuring trauma. Can we instead look underneath the skin? Can we look at biomarkers? Can we look at a person’s epigenetics to see what is happening inside their body? But as we do that, we need to also maintain ethics and morals.
How do I draw the ethics and morals of understanding? What do I do with the discoveries I make in science, because we were all scared of the runaway train of the discoveries of science. On social media, people talk about not just about biotechnology, but also playing God with babies, artificial intelligence, and so on.
Rana Dajani is professor of molecular biology at the Hashemite University, in Jordan.
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