Articles: Introduction to PTSD

Since I’ve already introduced general anxiety and explained panic attacks, it’s time to talk about Post-Traumatic Stress Disorder (PTSD). These days there’s a lot of claiming to be “triggered.” Regardless of whatever level of annoyance it’s come to reference, a trigger is– in fact– any stimuli (visual, auditory, olfactory, taste, tactile) or memory that the brain associates with a traumatic experience. Recall from my post on pattern recognition in the brain, that if we weren’t able to perceive– let alone remember– relatively consistent patterns from which we infer significance, we wouldn’t be able to navigate the world around us. Our senses (sight, sound, smell, touch, taste) give us information to which we attach meaning. Just as we learn what activities/ items hurt us (e.g. a hot stove burns, a wet surface is slippery), our brain can also make associations with things that aren’t necessarily related but have an equally negative connotation due to their relationship to our experience (e.g. nausea at the sight/ smell of food you last ate before vomiting).

Symptoms of post-traumatic stress include:

  • re-experiencing the trauma through intrusive memories, flashbacks and nightmares
  • emotional numbness and avoidance of places, people and activities associated with the source of trauma
  • inability to remember important details of the trauma (not due to head injury, alcohol, or drugs)
  • persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous”)
  • persistent, distorted blame of self or others about the cause or consequences of the trauma
  • persistent fear, horror, anger, guilt, or shame
  • markedly diminished interest or participation in significant activities
  • feelings of detachment or estrangement from others
  • persistent inability to experience positive emotions
  • irritability or aggressive behavior
  • reckless or self-destructive behavior
  • hypervigilance
  • exaggerated startle response
  • problems with concentration
  • difficulty falling or staying asleep or restless sleep

As I mentioned in The Flexner Report (part 2), in his book, The Body Keeps the Score (Brain, Mind and Body in the Healing of Trauma), psychiatrist, Dr. Bessel Van der Kolk recounts his early days in Med School:

“The Tuesday after the Fourth of July weekend, 1978, was my first day as a staff psychiatrist at the Boston Veterans Administration Clinic… In those early days at the VA, we labeled our Veterans with all sorts of diagnoses– alcoholism, substance abuse, depression, mood disorder, even schizophrenia– and we tried every treatment in our textbooks. But for all our efforts it became clear that we were accomplishing very little… A turning point arrived in 1980 when a group of Vietnam veterans, aided by the New York psychoanalysts Chaim Shatan and Robert J. Lifton, successfully lobbied the American Psychiatric Association to create a new diagnosis: posttraumatic stress disorder (PTSD)… This eventually led to an explosion of research and attempts at finding effective treatments.

The opening line of the grant rejection read: ‘It has never been shown that PTSD is relevant to the mission of the Veterans Administration.’ Since then, of course, the mission of the VA has become organized around the diagnosis of PTSD and brain injury, and considerable resources are dedicated to applying ‘evidence-based treatments’ to traumatized war veterans. But at the time things were different… in 1982 I took a position at the Massachusetts Mental Health Center, the Harvard teaching hospital where I had trained to become a psychiatrist. My new responsibility was to teach a fledgling area of study: psychopharmacology, the administration of drugs to alleviate mental illness…

In the late 1960s, during a year off between my first and second years of medical school, I became an accidental witness to a profound transition in the medical approach to mental suffering. I had landed a plum job as an attendant on a research ward at the Massachusetts Mental Health Center… MMHC had long been considered one of the finest psychiatric hospitals in the country, a jewel in the crown of the Harvard Medical School teaching empire… As an attendant I had nothing to do with the research aspect of the ward and was never told what treatment any of the patents was receiving…

I spent many nights and weekends on the unit, which exposed me to things the doctors never saw during their brief visits. When patients could not sleep, they often wandered in their tightly wrapped bathrobes into the darkened nursing station to talk… During morning rounds the young doctors presented their cases to their supervisors, a ritual that the ward attendants were allowed to observe in silence. They rarely mentioned stories like the ones I’d heard. However, many later studies have confirmed the relevance of those midnight confessions…

The way medicine approaches human suffering has always been determined by the technology available at any given time. Before the Enlightenment aberrations in behavior were ascribed to God, sin, magic, witches, and evil spirits. It was only in the nineteenth century that scientists in France and Germany began to investigate behavior as an adaptation to the complexities of the world. Now a new paradigm was emerging: Anger, lust, pride, greed, avarice, and sloth– as well as all the other problems we humans have always struggled to manage– were recast as ‘disorders’ that could be fixed by the administration of appropriate chemicals. Many psychiatrists were relieved and delighted to become ‘real scientists,’ just like their med school classmates who had laboratories, animal experiments, expensive equipment, and complicated diagnostic tests…”

We’ve certainly come a long way! A debt of gratitude is owed to those who’ve been brave enough to bring this issue to the forefront and genuinely seek to understand the phenomenon beyond merely labeling war veterans, “shell-shocked.” In future posts I’ll discuss this is further detail and explain the sub-types, along with how it manifests differently in children versus adults. For now, I’ve merely presented a summary because many people mistakenly think PTSD is something that only military personnel experience. Hopefully, we can not only move beyond ignorance but particularly flippant self-diagnosis that masks hyper-sensitive offense.

SOURCES CITED/ ADDITIONAL RESOURCES:

US Dept. of Veteran’s Affairs: National Center for PTSD

Anxiety and Depression Association of America

 

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