This Is Your Brain on Traumatic Stress: Remedial Neuroscience Lessons for the Pentagon

"The Pentagon has decided that it will not award the Purple Heart, the hallowed medal given to those wounded or killed in action, to war veterans who suffer from post-traumatic stress disorder because it is not a physical wound."
--The New York Times, January 8, 2009.

Lesson One: The mind is a property of the brain.

Lesson Two: The brain is located in the body.

Lesson Three: The hippocampus, a part of the brain responsible for our ability to have a conscious history, is one of the neurological casualties of traumatic experiences. It is damaged to the point of shrinking when saturated with a toxic flood of stress hormones. This not only leads to impaired memory. It also prevents the hippocampus from putting the brakes on the hair-trigger emotional responses of one of the brain's more primitive structures, the amygdala.

Lesson Four: Traumatic stress is often the result when soldiers are required to risk mutilation or death, to inflict it on others, or witness the maiming or annihilation of friends and comrades.

Lesson Five: Trauma sufficient to cause PTSD is no less physical than a bullet to the head.

Homework: Discard Rene Descartes' disembodied mind. Reread Gray's Anatomy.

Extra Credit: Read The Brain and the Inner World by Mark Solms and Oliver Turnbull, and take it seriously enough to ground your policies in science.

Comments

[electricsquirrel]

I absolutely concur that mental pathologies get short shrift from all corners of our society, and the DOD is no exception. Rather than fetishize a piece of metal, though, I'd like to see far more dollars pumped into research. I am a neuroscience PhD candidate, and I study mood and cognitive disorders in the context of glucocorticoids and the immune system. My lab is concerned with PTSD, depression, anxiety, and cognitive processing post physical and psychological stress, and I'd love to harness a small percentage of our military budget in order to solve this thing once and for all.

I need to offer one correction, with respect meant: The hippocampus is not implicated in inhibition of the amygdala. That would be the job of the pre-frontal cortex, rather. The ventral hippocampus does have projections to the amygdala and PFC, but they are not inhibitory.

[SharonWantsToTalk]

I'll never understand how psychological injury is considered less worthy of treatment than physical injury. Our psyche is everything. It is what defines us as human beings. I have taught my sons that people with mental impairments should be treated with the same respect as people with physical impairments. I tell them that the brain is the most complex part of our body. And when it has imbalances its no different than someone with physical imbalances such as diabetes. I also implore to them that serious life events can change the way the brain functions. War is the ultimate brain changing event. It goes against everything we are taught as human beings in this society. These men and women are absolutely injured. Injured deeper and harder to heal than most physical wounds. Its so obvious. Why would the Pentagon do this? What is the benefit of denying them?

[moAb]

The best thing we can do for these men and women who have served and have PTSD is give them great medical and psychiatric/psychological care. This is the least we can do. And, as one writer already noted, the spouses and children should be given recognition. In fact, they should appropriately be included in the health care plan of the service person or veteran. These current armed forces members and veterans should not be treated as problems and "costs". They deserve excellent care. They deserve much better.

[schatsie]

They need to give the Purple Hearts to their wive's and children who will never have the man back and who will care for them for the rest of their lives....

[DarkWitch]

Keep the Purple Hearts. Give these people proper treatment, disability money if appropriate, lifetime treatment at the VA hospital, education benefits, housing benefits, etc. At least give them as much as we got during the Vietnam era. And while we're at it, let's give those benefits to all Veterans, injured or not.

Time for America to step up.

[schatsie]

time for America to put their money where their mouth is... A tax on Republicans...

[sticksnstones]

I think the comment ... " At least give them as much as we got during the Vietnam era. " is a might misleading, and may well misrepresent the actual reality to those readers born after the Vietnam era.

We Vietnam vets had to wait for fifteen long years for the DVA to even acknowledge that PTSD was a valid service-connected condition ,and then were subjected to draconian bureaucratic paper mills, waiting lists, exams and re-exams, and basically, any roadblock the DVA could invent in a knee-jerk, on-the-run, off-the-cuff, blitz of red tape. I'm not making this up .... I lived it.

My own DVA claim for a PTSD disability benefit spanned EIGHT YEARS during both Democratic and Republican administrations, and was ultimately resolved in my favor after the retention of an attorney through a third party ( it was illegal to employ an attorney on my own, according to DVA regulations. )

Vets don't want anyone's pity, lip-service, or accolades. What they want and deserve is at least a down payment on the kind of care they were promised.

If you want to change the way vets are being screwed over, here's some free advise : Hold your elected representatives accountable.

[sticksnstones]

PS ..... The Department of Defense can keep their medals.

[SharonWantsToTalk]

If the Pentagon can't even muster a Purple Heart for these soldiers, what makes one think they could follow through with the rest. Shame on them. Who are these people that made this decision? Put there names on here!

[egal]

You shouldn't expect them to understand anything in the way of medicine, the human body, injury, or anything else relevant to health and health care. These are the same people who haven't established treatments for PTSD in women at all and have done so horribly badly for men,
who oversaw thousands of rejection letters denying any injury or responsibility for such damage to Vets and ActiveDuty soldiers just because of budgetary issues these guys caused to begin with,
and who encouraged military leaders to treat their soldiers like dirt if they dared become hurt in any manner that didn't involve compound fractures and arterial spurting.

How long, again, did it take for them to admit soldiers needed better benefits just because most of them were on food stamps and couldn't afford a secondary education with the GI Bill?

[BannedFromCommenting]

I m so tired of anything MENTAL not being considered PHYSICAL!!! Like the author says, the brain is part of the body and everything that happens within it is no less physical as it takes place in the tissues and chemicals issued BY the brain! Controlled BY the brain! Schizophrenia, paranoia, bi-polar, depression, all labeled "mental" illness. But its not like emotion, memory and all that is like surreal and intangible!

I mean how else can brain injuries cause amnesia? Is it THEN a physical injury? Though what you lose is "memory" that is considered a mental image?? Yet when you get seizures from a brain injury its now suddenly physical?

ANYTHING IN THE BODY IS PHYSICAL!!! PTSD IS CAUSED BY INJURY TO HOW THE BRAIN PROCESSES STRESS AND IS OVERLOADED!! THE CHEMICALS ARE MESSED UP! NOT MENTAL CHEMICALS!! ITS WHY WE CAN SYNTHESIZE DOPAMINE CUZ ITS PHYSICAL!!!

[PatA]

HuffPost's Pick

My SIL left for Iraq, the first time, as a reasonable, rational and happy person. This incident happened shortly after his arrival in Iraq. His unit hit an roadside bomb and his unit, for the most part, were blown to smithereens. As he tried to rescue his soldiers, their flesh was coming off in his hands. During this episode he injured his back and had surgery asap.
He came home, a stranger. He wasn't the young man that left that day at Ft. Sill, Oklahoma.
Second tour..he went back to Iraq with the back injuries and a diagnosis of PTSD.
He is back now and cannot function on a day to day basis. The marriage is collapsing and his
lovely little daughter is witness to a lot of verbal abuse and physical outbursts. His mental health
care is a mess.
And you say that people with PTSD shouldn't be recognized for their service? And another thing,
your dog just won't hunt in the comparison of WWII and Iraq and Afghanistan.
I'm leaving this discussion. I'm getting too upset.

[schatsie]

this type of trauma requires a significant investment in rest and relaxation for the brain chemicals to retreat/recalibrate... Think about the stress of being somewhere without body armor or with it in 130,,,it is frigging unbearable and then to be sleep deprived.. The conditions are inhumane....

I would suggest 30 days of intreatment someplace where he can reestablish a daily routine, the sleep issue just aggravates everything.. and then the memories....Hospice work clearly indicates that the actual loss is folllowed by 30 days of shock when even normal people cannot effectively cope all the time resulting in accidents and other incidents...Then there is the grief work and the fear of going back and never seeing family again...I had insomnia for 12 months when my son was in Iraq and am surprised I made it thru that without problems... I also had the fearful nightmare when I realized I wanted him to come home in any condition even if it meant he would not know his son and daughter.. my heart grieves for you... I hope Michelle is serious about getting involved with millitary families. I fear for his well being and yours.. We need for this to be treated aggressively so that people CAN eventually return to their normal lives,,,,whatever that is in this screwed up economy.

[avocats]

PTSD is very difficult to diagnose, and that makes the public suspicious. The Purple Heart has always been awarded for demonstrable physical injuries. My dad saw his best friend blown up in front of him, but got no Purple Heart. (He earned a Bronze Star for valor at another point.) If WWI and WWII and Korea and VietNam vets got no Purple Heart for the trauma of war that they suffered, why change the rules now?

[RadLeftVetPatriot]

My C.O. in Viet Nam got a Purple Heart for being struck by lightning.
WW1 "shellshock" was treated as an injury but alas, no purple hearts...
You sayin' PTSD is not a battle injury?

[egal]

The reason to change the rules now is that the rules wrong now were wrong then--those suffering from PTSD both then and now deserved the same status as those more obviously hurt--and we would be both traitors to our soldiers and utter morons to use our past failures as the excuse to continue failing our troops.

[schatsie]

The ONLY REASON it is difficult to diagnose is because we have not bothered to do the basic NEUROCHEMICAL assays to differentiate it from normal brains.... This is NOT rocket science...it is expensive to treat anything in this country and that is why we need UNIVERSAL HEALTH CARE FOR SOLDIERS AND THEIR FAMILIES AND ALL OF OUR CHILDREN...IT IS TOO FRIGGING EXPENSIVE... In France where they spend about half of what we spend per person, the mothers with c-sections stay in the hospital for 10 days of care and support...Here you change the diapers your self and get the boot after 48 hours,,, and the President of United Health GETs 1.6 BILLION DOLLARS... We need the GROSS overhead of the Health Care Establishment to be redeployed so WE CAN give proper treatment to the mothers and babies, the soldiers, the autistic and Alzheirmers AND DO THE BASIC RESEARCH to cure and prevent these conditions.

[Utopia]

Trauma is the result of physical force Though psychological injuries can often cause the same neuroplasmic reactions as say blunt trauma, so can't pleasurable activities and drug use. PTSD is a serious problem, now ban you seperate what caused it? No many times the symptoms overlap. One of the most common affects of PTSD is a constant reliving of that traumatic experiance, which hads neurochemical insult to the existing injury. Is PTSD a secondary symptom of a TBI? (Traumatic Brain Injury) In some cases yes. Is the loss of the limb due to a motor round as hard to define as those things just defined? No, that is why the Purple Heart is not awarded. As a medical professional with an emphasis in mental health (and awarded both the PH and Bronze Star) I can accept the DoD's decision.

[sensate]

This idea could also further the argument about the wide ranging near complete destructiveness of war. The damage goes on after the violence ceases like nuclear waste or toxic sludge.

[wisewomcat]

My brother has PTSD. That said, I think this is nonsense. Maybe we could try to redefine what merits getting a Medal of Freedom by saying "1.) Medal of Freedom is awarded to those who make a meritorious contribution to World Peace, 2.) a person who sits and watches TV all day does not engage in World War, 3.) by not engaging in war, they are engaging in peace."

So while your list of lessons may be factually true (just like mine), it doesn't represent the intent associated with the medal. And like another comment said, a lot of things can cause PTSD that have nothing to do with combat directly...and a Purple Heart

[knowBuddhaU]

Discard Descartes! Best advice I've read in a long time.

Note that the APA had no explicit member prohibition against participating in torture at the time of this post (1/24/2005):

~~~~~~~~~~~~~~
The military refused to give The Times permission to interview medical personnel at the isolated Guantánamo camp about their practices, and the medical journal, in an article that criticized the program, did not name the officials interviewed by its authors. The handful of former interrogators who spoke to The Times about the practices at Guantánamo spoke on condition of anonymity; some said they had welcomed the doctors' help.

Pentagon officials said in interviews that the practices at Guantánamo violated no ethics guidelines, and they disputed the conclusions of the medical journal's article, which was posted on the journal's Web site on Wednesday.

Several ethics experts outside the military said there were serious questions involving the conduct of the doctors, especially those in units known as Behavioral Science Consultation Teams, BSCT, colloquially referred to as "biscuit" teams, which advise interrogators.

"Their purpose was to help us break them," one former interrogator told The Times earlier this year.

The interrogator said in a more recent interview that a biscuit team doctor, having read the medical file of a detainee, suggested that the inmate's longing for his mother could be exploited to persuade him to cooperate.
http://www.kafka.com/politics/2005/06/biscuit-teams.php

[jmpurser]

I get your argument but I'm for the Purple Heart standards staying where they are. A LOT of things can cause PTSD that have nothing to do with combat directly. If I get shot I KNOW when and how I received my wound. With PTSD it isn't always so clear.

[RadLeftVetPatriot]

You know a lot of PTSD veterans then?

[NCGigi]

Well said, and I hope that the new leadership (PE Obama) will reconsider this decision.