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Learned Helplessness, Brain Injury, and the Pandemic

Learned helplessness is a default state that undermines brain injury recovery.

rebcenter-moscow/Pixabay
Source: rebcenter-moscow/Pixabay

Learned helplessness fascinated me as a psychology student at the University of Toronto. Seligman and Maier in 1967 came up with the term to describe a passive state in the face of shock. They hypothesized that when organisms experience no control, they learn nothing they do will escape them from trauma.

Seligman wrote in 1972:

“Dramatic successes in medicine have come more frequently from prevention than from treatment, and I would hazard a guess that inoculation and immunization have saved many more lives than cure.”

Seligman postulated that “behavioral immunization provided an easy and effective means of preventing learned helplessness.” In other words, experiencing control over trauma “may protect organisms from the helplessness caused by inescapable trauma.”

I thought of learned helplessness when my brain injury rehab began and, over the decades, when health-care professional after health-care professional told me to accept my injury. This advice confused me. I could understand it if I had not sought out treatment for my brain injury, avoided the prescribed homework, didn’t adjust my life to accommodate it. But I felt like I had to not only follow their prescriptions, but also agree with their attitude that brain injury is inescapable, and full recovery unlikely. I had to learn helplessness in the face of my catastrophic whole-brain diffuse axonal injury.

I refused.

Perhaps Maier and Seligman’s updated understanding of learned helplessness in 2016 explains why I could resist for over a decade. They explored the neuroscience behind learned helplessness and came up with a surprising explanation. According to Maier and Seligman, shock activates the serotonergic (5-HT) neurons in the dorsal raphe nucleus (DRN), which sends 5-HT to the periacqueductal grey and striatum where it inhibits active escape behaviour and, as well, to the amygdala, where it potentiates fear and anxiety. This is our default state — not our learned state. Prolonged exposure to trauma keeps these pathways, and thus passivity and fear or anxiety, active. For a person with brain injury, already overwhelmed by the injury and fatigue, this could add to or look like no motivation and continual anxiety.

Maier and Seligman explain that discovering one can escape shock creates the learned state. The brain detects the presence of control via a circuit from projections of the prelimbic region of the ventromedial prefrontal cortex to the dorsal medial striatum and back. After detection, another group of prelimbic neurons fire pathways towards the DRN that inhibit 5-HT release, changing the neural pathways so that the circuit learns to expect control. Future shocks then activate this circuit as one of expecting control.

Prior to my brain injury, I had experienced increasingly difficult health problems. Each time, I’d learned to manage and then once more thrive in the face of them. My prelimibic-DRN circuit changed to expect control. Constant reinforcement of this escape circuit over decades is probably why health-care attempts to have me accept the brain injury as permanent—that is, to be helpless—failed, until over a decade of their attempts ended with a highly experienced health-care professional, in concert with my family, shocking me enough to damage that circuit.

Maier and Seligman note that the circuit “provides an expectational function, in the sense that it changes or biases how organism[s] respond in the future as a consequence of the events that occur in the present.”

That shock event changed the expectational function of my circuit back to the default state. I accepted my brain injury as out of my control; full recovery as impossible, I’m helpless to heal the trauma. Yet there must be enough of the learned function left that activates escape behavior instead of passivity and fear because I continue to write about brain injury, advocate for appropriate diagnostics, and talk about effective treatments so that others can heal fully. But one thing I haven’t figured out is how to overcome the learned helplessness reinforced in me and my fellow brain injury survivors.

The variable pandemic measures, public response, and calls for making COVID-19 endemic remind me of learned helplessness, similar to how health-care professionals demanded that I accept brain injury as permanent. Polio and the worldwide drive to eradicate it provides a good contrast.

“There is no cure for polio, it can only be prevented…success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.” (World Health Organization)

In 1988, with 350,000 cases, the World Health Assembly adopted the polio eradication resolution because 0.5% of children developed permanent paralysis and 5 to 10% of those died—that is, 0.05% of all cases.

“Doctors have been estimating one-quarter to one-third of COVID-19 patients become long haulers, as many patients call themselves. Now, four studies published since February confirm that range.” (UC Davis Health)

Despite COVID-19 seeming to cause 50 times more disability than polio, we’re seeing an expression of the default state of passivity. Why? Is it about economic health? The WHO wrote that “Economic modelling has found that the eradication of polio would save at least US $40–50 billion.” Experts can only theorize COVID-19’s enormous economic cost.

As with my brain injury experience, there’s a long-term cost of learned helplessness, of not healing the injury or eradicating the virus. Not just the individual cost of a life of passivity, anxiety, isolation, dependence, and suffering, but also the economic cost of having us, and perhaps our caregivers, too, leave the workforce permanently.

How do we change our prelimbic-DRN circuits in the face of brain injury or pandemic from the default state to one whose function expects control? Maier and Seligman suggest: “from our circuitry speculation, it is the preparation for the future that is likely to be the most effective ingredient and so it is worthwhile to be explicit about the locus of its effectiveness.” Let’s start with having a goal, like polio eradication, that is a goal of a cure.

Copyright ©2021 Shireen Anne Jeejeebhoy.

References

Seligman, M. E., & Maier, S. F. (1967). Failure to escape traumatic shock. Journal of Experimental Psychology, 74(1), 1–9. https://doi.org/10.1037/h0024514

Seligman, M. E. Learned Helplessness. Annual Review of Medicine. Vol. 23:407-412 (Volume publication date February 1972) . https://doi.org/10.1146/annurev.me.23.020172.002203

Maier SF, Seligman ME. Learned helplessness at fifty: Insights from neuroscience. Psychol Rev. 2016;123(4):349-367. doi:10.1037/rev0000033

Meylakh N, Henderson LA. Dorsal raphe nucleus and harm avoidance: A resting-state investigation. Cogn Affect Behav Neurosci. 2016 Jun;16(3):561-9. doi: 10.3758/s13415-016-0415-6. PMID: 27007610.

Schipper P, Lopresto D, Reintjes RJ, Joosten J, Henckens MJ, Kozicz T, Homberg JR. Improved Stress Control in Serotonin Transporter Knockout Rats: Involvement of the Prefrontal Cortex and Dorsal Raphe Nucleus. ACS Chem Neurosci. 2015 Jul 15;6(7):1143-50. doi: 10.1021/acschemneuro.5b00126. Epub 2015 Jul 6. PMID: 26132384.

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