Little Wounds, Limbic Scars and Holes in the Street

German researchers recruited 110 people who were in hospital for Major Depressive Disorder. They scanned their brains with an MRI machine and gave them a questionnaire about childhood maltreatment. Two years later, they contacted the participants and asked them whether they had experienced in any depressive episodes since first contact. The researchers found that people who had experienced childhood trauma were more likely to have relapsed (not surprisingly). Both childhood trauma and depression relapse were associated with “Limbic Scars” – reductions in surface area of the Insular Cortex, a part of the brain associated with emotional regulation.

Depression can happen to any of us. Many things can set us up for a depressive episode: Losing a job, overwork, relationship difficulties, loneliness. Depressive episodes that happen once in response to a specific event are often simple to treat and over fairly quickly. Many depressive episodes are not simple one-off events. Some depressive episodes are recurring patterns, that come around every few years, and come under fairly similar circumstances. These recurring depressive patterns are mostly what I see in therapy.

Schema therapy was developed by Jeffrey Young, a student of the founder of Cognitive Behavioural Therapy (CBT), Aaron Beck. CBT is the evidence-based treatment-of-choice for a range of disorders including depression, social anxiety disorder, panic disorder, addictive disorders and eating disorders. Young’s great insight was that these conditions are often related to childhood traumas or maltreatment. Thus, even when treated effectively, the conditions recur. Young advanced the concept of schema to explain how childhood scarring leads to recurring adult disorders.

My clients often feel hopeless. They feel flawed. They feel like they take their problems with them wherever they go. They don’t know if its them or other people or the world. They realise they are trapped in a loop, but they don’t understand what it is, or how they got there. For these clients, insight is the first step. Then taking responsibility for changing. Finally, the process of change can occur. This poem, by Portia Nelson, describes the process well:

“I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost… I am helpless.
It isn’t my fault.
It takes forever to find a way out.


I walk down the same street.
There is a deep hole in the sidewalk.

I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place.
But, it isn’t my fault.
It still takes me a long time to get out.


I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in. It’s a habit.
My eyes are open.
I know where I am.
It is my fault. I get out immediately.


I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.


I walk down another street.”

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