HJAR Sep/Oct 2024

DIALOGUE 16 SEP / OCT 2024 I  HEALTHCARE JOURNAL OF ARKANSAS of our brain, in the prefrontal cortex. We use the prefrontal cortex of our brains all the time to make everyday decisions. For example, when you're driving a car, you don't consciously think, "Oh, the light is turning yellow. I'd better put my foot on the brake. I need to press on the brake now oh so slightly. If I press on it too hard, I'm going to slam everybody to the front." We don't consciously go through all of that in a formal way. We're doing it quickly. We're making decisions all the time, some of it based on experience, some of it based on just common sense. But when it comes to trauma, we're not making decisions, we're not thinking in the prefrontal cortex of our brain. The more rudimentary, older parts of our brains — the hypothalamus, the pituitary gland, and the amygdala — come into play. The amygdala is basically a little scanner looking for threats of violence, and as it's looking for threats, as soon as that scanner sees one, it's going to send a message to the hypothalamus. The hypothalamus is like a switchboard. I often think of one of those old-time telephone operators with a switchboard plugging in things left and right all over the place. So, when they get a signal from the amygdala saying, "Hey, there's a potential threat here going on," it's going to send a message down to the pituitary glands, and pituitary glands are basically going to say, "OK, we need to harness up some chemicals here, and we need to fight or flee this situation." And that's where we get into that fight or flight response. With that fight or flight response, there are four different chemicals that are typically released in response to trauma in order for us to be able to harness energy — it’s adrenaline. In order to be able to do that, there's a second hormone that needs to be released. If that second hormone is not released, then you could have all the adrenaline in the world, but you're not going to be able to do anything. You're not going to be able to stand and fight or flee and run away from the situation. That's where the freeze comes into play, and we call that tonic immobility, where you're just getting through it, whatever hap- pens. And we may be aware of it, we may not be. Often, we see sexual violence happening when people are taking advantage of people, when they're incapable of consent, as well. Alcohol is such a huge factor. It's the drug of choice that is used for taking advantage of people. So, it's not even necessarily that the body recognizes the trauma because of the fact that alcohol may have made them incapable of being aware of what's going on in the first place. Editor How do we erase the shame one may feel in being a rape victim? Wyandt-Hiebert I think, in part, by having open and honest conversations about sexual violence; by supporting survivors, victims who come forward; and by listening to what they have to say, not being quick to judge, not having the court of public opinion. Let the court systems figure things out. Also, understanding that even if it does go through the legal avenue, not all cases are going to make it to court. Unfortunately, so much of this happens where it's one person's word over another’s. That doesn't mean it didn't happen, and it doesn't mean that there's less trauma. Those individuals have suffered very much the same trauma as somebody whose case made it all the way through court and their offender was put in jail. It's very difficult to prove beyond a rea- sonable doubt within a legal court system the way laws are written and with the way evidence standards are when it comes to sexual violence and in the way that these cases happen and unfold. Until we can start holding people more accountable, it's going to be harder to make change. How do we start to make a change? I think the more we start to address the rape culture that we live in, the more we recognize the prevalence of sexual violence, the more that we recog- nize the elements that go into a rape culture, then the more we start to not feed into that rape culture. Why is it that music lyrics or movies romanticize violence? Well, that's because they’re what people are consum- ing. If we stop consuming those products, they're going to change. And entertainment is a consumer-driven industry. I think if more people become more aware and really start to have those in- depth conversations ... It can be on the peer level. You don't have to be the per- son standing on the state capitol with a sign protesting something and advocat- ing for new laws. That's great if that's you, but that's not everybody. For some people, it may be while they're watching a movie together with a group of friends and they see something, have the conversation then, "Wow, I was uncomfortable with that. That just didn't settle right with me. Anybody else feel that way?" Have those conversations in the moment. It's those little conversations when we are going to start to create more change, and they do snowball. We see that happen with many different things in our society — small things, people having everyday conversa- tions with each other. Then from that, they build. I think with changing sexual violence and changing the stats, it's really going to take a cultural change in our attitudes, our values, our beliefs, our systems of reporting and helping individuals who come forward and creating environments in which victims and survivors feel supported to come for- ward and seek help. Editor Do you think the Arkansas education system is doing a good enough job in educating kids and young adults about sexual abuse? Wyandt-Hiebert I think that any education system can always do better — across the board, no matter what grade level we're looking at — and not just schools, but within workplaces. I think that we can always do better with education that's engaging and impactful. How many times does somebody in their place of employment, for example, have to do an annual anti- sexual harassment training? And then, so often these days, it's just watching a video,