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Psychological Harm is Physical Harm 2: Why Survivors Lose Their Voice


Have you ever had that dream where something bad is happening to you, but when you try to ask for help, you can’t speak? You try to scream for help but you just can’t get the words out?

This doesn’t only happen in dreams. It happens in real life as well.

Survivors of gendered violence experience this all the time, and those who care about them may not even know it. Survivors may open their mouth and find nothing comes out. They may speak around what they want to say, have other words or disjointed narrative come rushing out, but find they can’t form the verbal thoughts they need to talk about the harm itself.

Conventional definitions of gendered violence include chronic systemic gaslighting as part of the Power and Control Wheel. Gaslighting over an extended period is abuse in all of the conventional understandings of abuse. Current insights in domestic violence work have incorporated this research. But it can take time for wider cultural understandings to catch up to the most current research and knowledge. Our culture has not fully caught up yet with the knowledge of why psychological violence ‘counts’ fully as ‘real abuse,’ every bit as violent and dangerous as beatings and rape. So why do conventional gendered violence programs include ‘making her think she’s crazy’ as part of the standard definition of abuse?

The reason gaslighting and making someone feel crazy are full-fledged instances of gendered violence is due in part to the severity of the impacts of these behaviours. The impacts are physiological as well as emotional and social. These forms of gendered violence can destroy people. Their impacts are not small or subtle. Here is why:

The reason survivors of gendered violence find it hard to speak are not, strictly speaking, ‘emotional.’ Abuse physically alters the brain and the nervous system in ways that impact cognition and speech. If this ‘can’t get the words’ experience has happened to you or someone you know, you’re not imagining it. It’s real, and it has a physiological cause.

Very real harm comes in many forms

Say, for instance, your partner is lying about something serious and telling you you’re crazy, or say their nonverbal behaviour makes you feel alarmed and you can’t figure out why, and they tell you you are imagining it. Say they appear to be seeking control in covert ways, or using subtle manipulation tactics to destabilize you.

An emotionally responsible, ethical partner, when you bring this up, will want to hear your concerns and address them openly and honestly, with integrity, accountability, and self-awareness.

In an abusive relationship, if you raise these concerns, instead of acting in an emotionally accountable way, your partner may gaslight you, making you believe you are imagining it, or may deny the alarming behaviour is happening at all.

In this kind of ongoing harm, as described below, our body’s alarm systems are going off, releasing stress chemicals into our system on a regular basis and putting our bodies on high alert, and we are trying to make sense of the signals. If the person harming us does not come clean, whether because they are not self-aware about their issues or because they feel the need for control, if we trust them, and particularly if the harm falls along other lines of power, we may doubt ourselves. Our ability to make sense of our body’s cues, and hence to end the physiological alarm and return the body to a state of balance, is impaired by our inability to get accurate information, or by a lack of integrity on the part of the person causing harm.  In abusive relationships where chronic, serious gaslighting is a factor, this state of elevated distress can go on every day for months or years.

Over time, as the five examples below explain, this physiological experience can destroy your physical ability to think and speak, until you are able to get away from or interrupt the abuse and repair the physical injury it causes, which can in some cases be quite severe.

The physical impacts described below are a big part of why serious, chronic gaslighting abuse, especially when the survivor is open, trusting and vulnerable and does not realize they need to erect barriers to the abuse – is as dangerous to physical brain structures as battery or rape.

If you care, and yet are not a survivor yourself, what you can do to help is to take it upon yourself to learn more about the signs and symptoms – and causes – of physiological silencing described below. Being able to recognize the signs of blocked speech allows you to care for survivors with compassion and understanding, so you can carefully, lovingly, help them come back into language about what is happening to them before you do anything else.

Here are five things that happen physiologically in response to gendered violence that make it hard for survivors to speak:

1. A key language centre in your brain temporarily shuts down

Broca’s Area is a furl of neural matter in the left half of your brain, behind your left temple, above your left ear. In this diagram it is the smaller orange patch on the left.

Broca’s area is involved in the production of words and sentences, both inside your mind and spoken out loud. During trauma  “Broca’s area – the part of the left hemisphere responsible for translating personal experiences into communicable language – is turned off.” Replicable studies that examine brain scans of people with PTSD indicate that Broca’s area gets deactivated during recall of traumatic stress.

The British Journal of Psychiatry notes: “A replicated finding has been the deactivation of Broca’s area, the area of the brain thought to be responsible for applying semantic representations to personal experience to allow its communication or description. This would appear to be consistent with subjects with PTSD having difficulty in cognitively restructuring their traumatic experience.”

In other words, a core speech area of a survivor’s brain shuts down during traumatic events, and shuts down again any time the survivor attempts to even think about that traumatic experience. This may help to account for the “speechless terror” experienced by survivors.

Speechless terror can sometimes look – mistakenly – like anger. If someone you care about appears ‘angry’ but they tell you they are terrified, they may be experiencing this intense difficulty speaking about experiences of harm. They may try to tell you this, or they may not even be able to let you know it is happening.

You can help them by asking them ‘are you finding it hard to speak?’ And asking gentle questions such as “Was it like this? Was it like that?” and listening very deeply, willing to expand your understanding of how abuse works.

2. Another part of your brain, that connects information together, is injured by traumatic stress

Moving from Broca’s area, let’s slide inwards a little, to a structure called the hippocampus, which in traumatic stress is also significantly harmed.


The hippocampus is a fascinating part of the brain. It is involved in ordering emotions, memories and events, and in spatial and sequential memory.  Called the “hippocampus” because it is vaguely seahorse-shaped, this important area is in the limbic brain, below the ‘thinking’ neocortex and above the ‘basic survival’ brainstem.

Say you have a dinner party. Your brain will store information in different networks all over the brain for the taste of the wine, who was there, how you felt, the way the flowers smelled or the candle’s heat. In a healthy brain, the hippocampus keeps track of and connects these different networks together to form one episodic memory.

In other words, this part of the brain helps us remember it all as one connected life event.

The area of the brain where the hippocampus is located is the most relational part of our brain, the part that developed when mammals began to grow inside a parent’s body rather than in an egg. Since our limbic brains keep us alive by keeping us connected to the people who matter, this part of our brain is exquisitely attuned to interdependence and the rhythms of human connection.

This cortisol-sensitive part of the brain gets damaged by chronic elevated stressThere is a relationship between chronic elevated cortisol levels and hippocampal atrophy, and some evidence to suggest that chronic elevated cortisol levels can cause lesions and shrinkage in the hippocampus.

PTSD research indicating shrinkage in hippocampal volume

The responsiveness of the hippocampus to cortisol means when someone is experiencing the chronic stress of ongoing psychological violence, they may have a harder time thinking of things together that are typically brought together in consciousness, even when they know what has happened to them.

Parts of the experience, sensory information, and emotional knowledge become disconnected, causing fragmentation and dissociation: the inability to bring together elements of consciousness that are typically thought of together.

The damage caused over time to the hippocampus from this chronic distress can cause a weakened capacity to hold the parts of experience together. Psychological violence is thus compounded, and the survivor rendered less able to defend themselves as time passes, because of physical, neurological harm caused by the abuse.

The hippocampus is deeply woven into the autonomic nervous system and all of the lower survival functions, and is connected with the Hypothalamus-Pituitary-Adrenal (HPA) axis, an important part of the stress system in your body that affects many other systems.

The disruption to the hypothalamus and pituitary that this kind of chronic distress causes can disrupt sleep patterns, causing insomnia that is not about ‘having worried thoughts’ but is actually a disruption in the brain’s operation.

So when a person causing harm creates chronic stress in their lover or partner, for instance by gaslighting them every day for months, even if they never lay a hand on them they are physically injuring that person’s brain in ways that take years to repair.  And that’s not all:

3. The body’s fight-or-flight trigger gets more responsive over time

Moving along inside the limbic brain, we come to the amygdala. The amygdala is an almond-shaped structure in the brain involved in observing the outside world to scan the environment for signs relevant to our survival, such as the potential for sex and attachment, food, rivals, children in distress, risk and threat.

In situations of chronic stress (e.g. soldiers in combat zones, QTPOC experiencing daily oppression, survivors of gendered violence, etc.) since the stimulus is continual, the amygdala over time develops a greater and greater sensitivity to traumatic stress. It starts pumping out more distress signaling over time.

Because it is in communication with the rest of the nervous system, this signalling affects lots of other systems in the body. For instance, ongoing traumatic stress can impair the prefrontal cortex, shattering a survivor’s capacity for higher-order thought.

All of these systems are connected, which brings us to the fourth point:

4. The stress response system in your body creates a loop.

Moving from the brain down out through an opening in the bottom of your skull, imagine travelling along your vagus nerve, the largest nerve in your body.

The vagus nerve connects your brain to virtually every other organ and system, and it is an important part of the body’s ‘gearing up’ and ‘gearing down’ systems.

Here is our friend the vagus nerve, running up and down the body, in yellow:

When the amygdala determines that it is in danger, it initiates a hormone cascade that activates the HPA axis, so that the signal in turn shoots down to the adrenal glands, situated just above your kidneys:

…which pump out a rush of stress hormones including adrenaline and cortisol, that flood into the bloodstream and up the vagus nerve and overwhelm the cortisol-receptive hippocampus, which, as mentioned above, can create long-term (but thankfully repairable) damage to this structure in the exquisitely sensitive limbic brain. ‘Static’ signalling can build up in the vagus nerve, resulting in cumulative stress and trauma responses that require systemic repair.

Combine fragmentation, impaired prefrontal cortex activity, sleep disruption, and the shutting down of a key language centre, and you have a potent physiological silencing of survivors – before they ever get so far as to verbally ask for help.

Once survivors manage to speak up and break through this physiological silencing, then they also face the social silencing and backlash built into our culture.

These compound, piling silencing on top of silencing, and abuse on top of abuse.

So while victim-blaming and bystander dynamics are culturally conditioned in our society, our bodies simultaneously silence us physiologically long before we even ask those around us for help.

More than a metaphor

Survivors often use metaphors to describe this compounding of physiological silencing that happens in our bodies. The ‘well of silence’ is a common metaphor.

Many describe a feeling like drowning, like the abuse and gaslighting push your head underwater. Anytime you try to talk or think about what is happening, you can’t reach others for help because the words just won’t come.

However, this drowning metaphor rarely brings about the kind of support that is called for. Metaphor only helps if the listener already shares your experience and knows exactly what you’re talking about. If bystanders haven’t had a shared experience, trying to explain it through metaphor may not tell them much. They may just not get it.Survivors report the experience that they are speaking but it is as though they are making the sounds of the Charlie Brown teacher. ‘wawawamwamwamwawa,’ as though no one can hear even when they can manage to express what is going on.

Interestingly, ‘drowning’ may actually be a parallel physical experience rather than just a metaphor. The body has multiple physiological survival functions that are not in our control. My hope is that the more readers understand what is happening physiologically, the fewer survivors there will be who have to go through this alone.

True drowning doesn’t look like drowning

Unlike on TV when people shout and wave their arms, in real life drowning, the Instinctive Drowning Response overrides the neocortex. A drowning person becomes physiologically unable to control or direct their own limbs.

This survival response blocks voluntary control of the body and creates a life-threatening stillness and inability to call for help.

Perhaps the physical similarity between drowning and other losses of executive control (control by your conscious, willing self) are why ‘drowning’ is the closest description many survivors have when attempting to describe this experience.

Which brings me to our last item in the list:

5. A different loss of executive control, akin to the body’s drowning response, can lead a survivor to completely freeze during assault

A different, parallel response to the drowning response,  tonic immobility,  paralyzes the person experiencing harm and leads them to be physiologically unable to fight, speak, or call out for help. This system appears to arise when our bodies decide we are being eaten (as in, by lions), and there is neither time to flee nor ability to fight back. The body becomes immobilized.

Because most people have not heard that this can happen, survivors may blame themselves for this immobility, when it is utterly not their fault. This experience of involuntary immobility causes understandable stress to the system, and triggers the loop described above.

Psychological harm is physical harm

As the examples above suggest, the brain and nervous system damage caused by psychological violence is every bit as debilitating as more visible harm. While the brain does repair itself, it can take many years and medical support to heal, medical support that not everyone can access.

Because the physical harm caused by things like chronic gaslighting is only visible on an MRI, bystanders may need to really listen with a lot of extra care and empathy in order to take the harm seriously, because while it is every bit as physical as a cut or a bruise on the skin, the physical injury is inside the body, hidden from view.

If bystanders don’t know how to listen really deeply to hear the truth, and imagine what the harm has done to the survivor’s brain, the original harm can be compounded when those who are nearby create secondary abuse by gaslighting the survivor again until they take the time to see the severity, and the root cause, of the harm.

I cannot waltz into an MRI lab and say, ‘hey, he damaged my HPA axis, my hippocampus seems to not be working, I think my pituitary function has been damaged, and it seems Broca’s area keeps shutting down. Can you take a scan of my brain, please and thanks?”

‘Psychological’ harm is thus a misnomer. This kind of abuse causes physical harm to brain structures and is as physically violent as harm to one’s more readily visible body parts.

The harm in this kind of abuse is to the delicate brain and inner functioning of the nervous system. So when we talk about bravery, about the strength, dignity, and power of survivors who speak up, we are talking about a lot more than just the guts involved socially in ‘deciding to tell’ in a culture that still shames survivors just for experiencing harm, or penalizes women and queer folks for speaking up rather than drowning in silence. What is often overlooked and underestimated is just how much literal physiological silencing survivors struggle through before they become able to speak at all.

When you combine the physical silencing of the body with the social silencing of structural violence, in which survivors are blamed, shamed, or ostracized for speaking up, and those who harm – especially if they are cismen – are buffered socially from even hearing harm they have caused, it becomes clear why those around the survivor who can see cannot speak, and those who have the capacity to speak can feel entitled not to see.

If someone you know has been quiet quiet quiet in a relationship over months and then “abruptly” begins pleading or shouting for help, ask yourself what has been happening to them beforehand. What has been going on quietly for weeks and months? What did you miss over months or years of wordless terror that has at long last made this attempt to get heard their last desperate option? If someone is trying to get heard through physiological paralysis, sometimes the only options can be deathly silence, or shouting to get around the inner block. True drowning,  whether in water or in abuse, can look very quiet.

How can you help?

Different survivors need different things. If a survivor has been gaslighted, they may have a powerful, and very normal, need to see the whole undistorted truth named clearly by those around them. A central part of healing from gaslighting entails the creation of a coherent narrative. Most crucially, someone who has been brutally silenced in this way may need to be heard. Needing to name the whole truth is a normal and very healthy part of healing when your trust in your perceptions have been badly undermined over a long stretch of time.

Unfortunately, those who cause harm often derail accountability and find ways to repeatedly recentre themselves: their intentions, their guilt, their feelings, their shame. They may feel entitled to refuse to hear. They may even continue to gaslight the survivor after they get called on it by many people around them, because whatever leads them to need control is still there. In a culture that conditions us to normalize and rationalize harm, our position as bystanders will include several significant culturally-conditioned distortions that lead us to be unable to perceive the situation accurately.

If you are a bystander, a good thing you can do is simply to keep this awareness in mind. Centring the survivor is crucial. If the survivor wishes it, bystanders can gently but firmly tell the person who caused harm that this story is not about them, that it’s time to centre the needs of the survivor now.

No one is expendible, no one needs to be shamed. But no matter how the person who caused harm may feel about it, accountability and shaming are not at all the same thing.

Do not go on with ‘business as usual,’ acting like nothing has happened. In a culture that normalizes harm, a culture that teaches us to ’empathize up’ and ‘punch down,’ there is no level playing field, and ‘neutral’ is not neutral. Going on with business as usual communicates to survivors that you do not care about their safety, and is extremely detrimental to their wellbeing. Do not allow this reality to get erased. Remember it is real and act accordingly.

Where the abuser is incapable of accountability, or feels entitled to evade, what you can do as a bystander is to communicate clearly and openly to the one who caused harm that accountability is expected. Where accountability is denied, close ranks around the survivor, to ensure they do not get doubly-punished for the harm done to them.  

Be aware that ‘neutrality’ is not neutral when you are playing on a cavernously unequal playing field. We still live in a culture that reflexively attacks and shuns survivors simply for speaking up. Fighting survivor stigma by ensuring survivors are supported, protected, believed, and included is a big part of how bystanders can act in ethical ways.

Whatever you do, now that you know how hard it is for survivors to speak, when a survivor comes to you, I hope you will know to listen deeply and slowly, aware of the physiological and social silencing they are struggling with.

And if this is you, if you are a survivor and you’re seeing yourself in these words, know: it can heal. This can all heal. It takes nurturance, and care, and support, and is certainly helped by allies who stick up for you. In the long run it takes retraining your nervous system back to rhythms that gear down. All the evidence suggests over time it will repair itself. But don’t waste thoughts worrying if it is real. It is absolutely real, and it can heal under the right conditions.

Spread this knowledge. So the next time a survivor is trapped in worldless terror, more of us will know what is happening and how to help.


How can we create a more caring culture? Read more:

The Opposite of Rape Culture is Nurturance Culture

Hold Together: We Need Conflict Skills Now More Than Ever

On Nurturance and Vulnerability in Academic Life

Do you want to help? Please share widely!  Give this to survivors you know and help those around them learn what gets hidden and erased.

With a little help and compassion, caring and understanding, survivors can get the help and solidarity they create conditions of safety in communities. Those conditions of safety are a core part of the recipe for healing. You can be part of it. Please pass this along. 🙂

Additional Resources:
BYP100 Community Accountability Process (I highly recommend this)
 community accountability process
Philly Stands Up

The Revolution Starts at Home
Bay Area Transformative Justice Network

For further reading:

Special thank you to Melissa A Fabello, editor at Everyday Feminism, for in-depth revision suggestions that helped structure this piece.

Mo Daviau’s writing on this also rings true

See the viral post The Opposite of Rape Culture is Nurturance Culture

If you realize you have harmed someone in this way, and you need to take ownership and begin to fix what you have done, here is how you practice accountability in a healthy, responsible way: Own, Apologize, Repair: Coming Back to Integrity

This video from Everyday Feminism is also great, and I highly recommend you watch it and take in carefully what she is saying.Owning and apologizing doesn’t centre you. It is not about your intentions or your emotions. It centres the person you have harmed. Name your harmful acts, take the time to fully hear and fully internalize how they caused harm, express your remorse and empathy in a respectful way, and calibrate to attune your offer of repair so it addresses the harm you caused. Compassion for why what you did is understanable is good but it’s not the ‘owning’ part.

For more on working with your internalized shame or self-loathing, which are the barriers to accountability after harm, here is a piece that looks at how you can heal the fear of being ‘not good enough‘ that prevents accountability

Do you love speculative fiction and social justice? I’ve written a speculative fiction novella that explores the transformations our planet is undergoing and the undoing of cultures of domination. Cipher is currently exploring agents and publishers. Help finding its wings is welcome! Learn more about Cipher here.

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