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THE SAM MODEL OF DYNAMICS AND EFFECTS
An excerpt from Chapter 4

This section describes ways in which SAM, or a sexually abused male, can experience the biology of childhood sexual abuse.

The perpetrator's glare. SAM's wince. The smell of bourbon seeping from pores. The sound of bluejays chirping. The taste of uninvited flesh. The boy witnesses the invasion of his body, hearing the words, "I love you," as pain seers through his rectum. Exertosensory and interosensory data begin their voyage, from the sensory filter to the thalamus to the limbic system. Fear registers as an impulse in SAM's amygdala. The anterior hypothalamus generates the sympathetic arousal of the autonomic nervous system. The sympathetic nervous system regulates hormone secretion and prepares SAM's body for action by way of nerve chains originating in the cerebral cortex and projecting throughout the body. Upon activation of the sympathetic nervous system, the amygdala triggers the adrenal medulla into action. During the fight-or-flight response, adrenaline, the chief sympathetic neurotransmitter, discharges epinephrine and norepinephrine at the nerve endings, thereby inducing manifestations of hyperalertness, increases in respiration, perspiration, metabolism and, perhaps, fear and confusion, too. Aroused by this sensory and sympathetic stimulation, the parasympathetic nervous system strives to circumscribe the body's reactivity. However, as subjection to CSA threatens SAM's homeostatic state, his hypothalamus, pituitary gland and adrenal gland, or HPA axis, recruits neural pathways, rallying his heart, his lungs, his skin, his respiratory, circulatory, immune and metabolic systems, some suppressing, others unleashing, all in due order, with the aim of coping with, adapting to and outlasting the immediate trauma. The catecholamines signal the hippocampus, tightly binding the ensuing memories for the long term while suppressing the frontal regions of the brain, thereby relieving the ensuing memories in the short term. With a keen balance of power, the complementary nervous systems automatically and unconsciously regulate and adjust SAM's body to the impending danger, permitting the frontal cortex to willfully and consciously pursue sensory data in service of interpreting, calculating, problem-solving and making it through, one moment to the next. The hypothalamus and the pituitary power up the brain stem, the diencephalon, the limbic system and the cortex, galvanizing the sympathetic nervous system once again to spur his body into high gear. Blood flows, priming SAM's brain, coaching his muscles and preparing his lungs for the perpetrator's attack. Pupils dilate. Nostrils flare. Heart races. The scalp tightens. Muscles contract. Mouth dries. But SAM can't run. Digestion ceases; stomach churns. Limbs tremor. Head buzzes. Senses heighten. But SAM can't hide. Immune-boosting troops traverse to the front lines to fight and ameliorate potential infection or injury. Vision may narrow, hearing may amplify. Hands tingle. Lungs spasm. He sweats and trembles. SAM feels "pins and needles" throughout his body. Bowels discharge. Stomach heaves. Fear of vomiting. Of going crazy. Of reality. Of the unknown. Norepinephrine—charge onward! Epinephrine—retreat! Cortisol marshals the body. Serotonin inhibits. Dopamine exerts control. Acetycholine strengthens movement. Glutamate enhances long-term memory. GABA relaxes the body. Opioids camouflage his pain. Inhibition! Excitation! Fight! Flight! Freeze! Persevere —and that's exactly what he does, no matter what.