After the American Civil War, they called it Soldier's Heart. Veterans of World War I suffered shell shock. In World War II it was battle fatigue. After the Vietnam war, which produced so many sufferers of the condition, it came to be known as Post-Traumatic Stress Disorder, or PTSD. It has recently been realized that traumatic situations having nothing to do with war can precipitate what is essentially the same condition in civilians. Thus, the term post-traumatic stress disorder may be the most appropriate name for this psychiatric disorder.
There is controversy, even among mental health professionals, about what types of trauma can precipitate PTSD. This becomes a critical issue when situations such as the rampage of Army psychiatrist Nidal Hasan raise the question of whether psychiatrists who treat soldiers with PTSD can develop a secondary or vicarious PTSD, and thus be at risk for engaging in violent behaviors. I must note that this concern about violence in sufferers of PTSD is an exaggerated one. Although many veterans are returning from Iraq and Afghanistan with PTSD, the perpetration of homicide by these veterans is no higher than what is seen among non-veterans of that age group. These unfortunate veterans tend to destroy their own lives far more often then they harm others. Nonetheless, the fear is that the sufferer of PTSD will experience a "flashback" and in a state of believing they are back in the traumatic event they might act out violently and uncontrollably against innocent individuals.
I recently wrote in the Huffington Post that Dr. Hasan did not suffer vicarious PTSD. I think the evidence now shows that Hasan's violent behavior arose out of political and religious motives and was not driven by PTSD. Nonetheless, the controversy stimulated by my views was compelling enough to lead me to revisit the question of what PTSD actually is and what types of traumatic situations can cause it.
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, is the bible of diagnosis in psychiatry. According to the DSM-IV, an essential component in the triggering of PTSD is "the direct personal experience of an event that involves actual or threatened death or serious injury; or witnessing of an event that involves death, injury or a threat to another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate". The DSM-IV further states that the person's response to this event must involve "intense fear, helplessness, or horror". Personally, I am skeptical about the last category of factors thought capable of precipitating PTSD. However, while I am willing to accept that learning unexpectedly of a gruesome fate of a member of one's family might trigger PTSD, neither I nor the DSM-IV believes that this carries over to strangers.
The symptoms of PTSD include re-experiencing of the traumatic event in nightmares, intrusive thoughts, "flashbacks" of the event, or in being severely distressed by reminders of the trauma. Another symptom is social withdrawal and avoidance of the crowds, places, and things that might remind one of the traumatic event. There is also a numbing of feelings and a "sense of foreshortened future", in which an individual feels that their life is essentially over. Other primary symptoms of PTSD are hypervigilance, ease to startle, insomnia, irritability, anger, and difficulty concentrating.
The intrusive thoughts, flashbacks, and persistence of the hypervigilant state all point to a condition in which the sufferer is to some extent no longer able to clearly distinguish "here and now" from the "then and there" in which the traumatic event occurred. PTSD involves pathology in brain function that leads to a loss of context in re-experiencing the trauma. This loss of contextualization, the diminished ability to distinguish "here and now" from "then and there", is the sine qua non of PTSD. If there is no horrifying, fearful event, then there can be no intrusion of that event into the present. If Hasan or another psychiatrist developed PTSD from hearing stories of soldiers in combat, what trauma could possibly be intruding into their thoughts? Would it be images of their office? Would it be the horrible feeling that they are actually back in time, safe and sound in a leather armchair while listening to a soldier talk about his disturbing war experiences? For this reason alone the notion of vicarious PTSD is absurd!
There are many significant psychiatric problems other than PTSD. To say that a form of suffering is not PTSD is not to diminish its importance. For example, constant stress and disillusionment from listening to stories of death and trauma can exacerbate or even cause the serious illness of Major Depression. Nonetheless, there are aspects of PTSD that cannot be generated by common disappointments and stresses of life, nor by the experience of treating a soldier who has suffered severe trauma.
What of those who emphatically state that they suffer PTSD, but do not? It is possible for someone to think that there is something very wrong with their heart and be mistaken about it. Despite what they think, they do not actually have a cardiovascular disease. However, psychiatry is complicated by the fact that if someone thinks there is something wrong with their mind, then, by golly, they are right! Thus, a psychiatrist cannot simply dismiss any patient's statement of feeling traumatized, due to the fact that if the patient believes it then they are in some sense correct. It doesn't matter if this sense of trauma is based on having lived through an airplane crash or merely having suffered being goosed on an elevator.
The question for the discerning psychiatrist is whether or not the individual's subjective, and thus real, sense of trauma is due to PTSD, or if it is better categorized as something such as Major Depression, an anxiety disorder, or a personality disorder in which the response is far more dependent on pre-existing problems in the individual than on the nature and intensity of the allegedly traumatic event. Thus, while it is possible for someone to feel traumatized and claim PTSD from having been served a well-done steak that was ordered rare, I would likely not give the diagnosis of PTSD.
Claims that mental health workers are at risk for PTSD from treating their patients add an unnecessary layer of confusion to the question of how we can best serve our soldiers and veterans. This is particularly dangerous at a time when the military is short of mental health professionals and the need for their service is growing. In view of what we know about the nature and cause of PTSD, I believe the military should concern itself first and foremost with providing an adequate number of well-trained psychiatrists and psychotherapists for our troops suffering the traumas of war, and be less concerned about potential dangers these mental health professionals might face in treating them.
Dr. Mendelson is the author of the new book, Beyond Alzheimer's.
Posttraumatic Stress Disorder (PTSD) Causes, Symptoms, Treatment ...
i have personal expereinces that i dont choose to share here, but i can tell you meditation has been extremly helpful to me. i know ptsd doesnt come in a one size fits all, and i am a little dissapointed in the artical above which doesnt even adress this and is one reason why ptsd sufferers dont get proper treatment imo. when you are sent into repeated situations over a long period, it changes the complexion of the ptsd. its different when you have one incident compared to years of it. i am not converting you but read the dalai lamas books, he has practical adivce that imo is as important as the behind the scenes internal work.
just know someone way out west is thinking of you and hoping you find the peace of mind you so richly deserve.
SD Mendelson
http://en.wikipedia.org/wiki/Eye_movement_desensitization_and_reprocessing
It is expressed in those that abandon humanity and seek to join groups that enable the killing of other humans for "acceptable" reasons.
Everyone that behaves in such a manner is already crazy and predisposed to the results of faulty wiring.
This is why the GOP represents the wingnuts that murder doctors and so on.
They represent PRE traumatic stress disorder endowed individuals better than the Dems do.
But only just slightly so.
One symptom that expresses in our representatives is that in some fashion it becomes more important for that representative to KEEP their seat, than it is for tham to do the right thing.
Every one of our congresspeople need to be voted out every single election, but another symptom of the disorder is that people lose tha ability to pars reality and become sheep and believe advertisements.
Whichever is played more and whichever is more traumaticly selfish and ugly as long as it seems to be patriotic and makes somebody into an "enemy" or provides some basis for "fear".
We suck.
PTSD can and should stand for PRE truamatic stress disorder.
It is expressed in those that abandon humanity and seek to join groups that enable the killing of other humans for "acceptable" reasons.
Everyone that behaves in such a manner is already crazy and predisposed to the result
***********
to linksync....people who have to deal with the worst of humanity suffer ptsd. rapes, beatings, all manner of horrific abuse you name it and you say they abandone humanity.
projection went into play when you said we suc.
I won't go into the physical damage done to me because some of it is gross. The two cracked teeth was the least of the damage. The physical part was gone within 3 months so I'm over it.
However, the psycological damage will be with me forever I would imagine. I was making prgress until my insurance company cut off my therapy coverage. I have nightmares that are so vivid and real about my ICD going off. My days are filled with panic attacks and I jump even if the phone rings. Life is not fun on the surface but I've never gotten depressed, just angry that it happened and I'm in a constant state of anxiety. I refuse to miss life, I just say bring it on. I'll deal with it.
There weren't any gunshots or violence involved in my PTSD. My father has Alzheimers ended up in the ER Thursday. Just walking into a hospital causes flashbacks. I'm getting good at walking with double vision.
S.D. Mendelson
Funny you should mention the experience of waking up during surgery. That happened to me during the first implant twice. It shocked everyone in the operating room. It happened while they were testing the ICD. They were still talking about it several days later. On top of that, according to the surgeon, they had to give me twice the amount of anesthesia just to get me to sleep as he had given anyone in his entire career. At least they were prepared during the second surgery after my ICD went crazy, and as they described it to my hubby, they "toasted" me. LOL!
It helps enormously for us to be able to retrospectively identify perceptual and response options which would have been available to us when the event first happened, but which we failed to identify at the time, and/or options which have become available to us since the original event by virtue of our increased fund of experience and other resources we have acquired in the interim. That opens up the opportunity to begin to choose our response, which, in turn helps us to begin managing the whole process.
Healing from trauma is possible in most cases, but difficult to do without a guide who understands the phenomenon.
As for secondary trauma - I'm not prepared to rule it out, but anyone who experiences it is likely predisposed by virtue of other unresolved experiential issues which increase their vulnerability.
Any therapist who is not seeking out and using a competent personal therapeutic supervisor is risking burnout at best and disaster at worst especially when they have significant unresolved emotional issues of their own, as I suspect that Major Hasan does, quite apart from his religious and political perspectives.
David E. Brown, MS, LMHC
Then, when we subsequently experience triggers which remind us of the original event, even though we may not currently be under threat, the threat feels real enough to drive us to relive our perceptual and emotional reaction to the original event and respond as we did when the trauma first happened.
Until we can begin to manage this process, each flashback reinforces our original traumatic response. Then our sense of being trapped in the cycle triggers despair that our lives can ever be free of these experiences.
When we can begin to realize, even post-flashback, that we are responding to a perception of threat rather than a true threat, we can begin to cognitively counter that perception and gradually dissipate the emotions that perception triggers, and free ourselves from the clutches of our original experience.
About two months into my job, I noticed changes in my habits and thinking. I refused to sit with my back to the door, always planned out an escape route, and immediately locked my door when I got in my car or home. I started sleeping with the TV on at night. Every man I encountered was a potential rapist, so I made sure to never allow one to walk behind me or get close enough to reach out and grab me. My startle response went through the roof. In short, I became hypervigilant.
Then I began experiencing bouts of insomnia and repeated nightmares about fighting off and/or killing a would-be rapist/murderer. It was at that point that I realized my job had officially 'gone to my head'.
While I do not believe the severity of my symptoms merited a diagnosis of PTSD, I do think what I experienced falls under the heading of "vicarious tramatization". Whatever you wish to call it, it was disruptive to my life and overall peace of mind.
After my research I believe in the adrenaline "groove" modeling of the brain and that this triggers past feelings when more adrenaline is triggered, for what-ever reason. Talk to people with PTSD and when they are under stress, no matter what the reason, it gets worse. Some people are surprised when they think they are over something and 20 years later when a major stressor occurs, they get everything back again. I believe it has a lot to do with brain chemistry, at the event and the same chemistry that causes a relapse. I agree that you cannot "catch" PTSD and to imply or endorse that you can is offensive to me.