From Chapter One
What Is PTSD?
This is the story of post-traumatic stress disorder, also called PTSD. The typical term before PTSD was "shell shock," and it was only considered as a weakness in soldiers. PTSD was first considered a disorder when Vietnam War veterans returned with the symptoms listed below, which later became the basis for diagnosis.
The essential feature of PTSD is the development of characteristic symptoms in the senses of the individual following exposure to an extremely traumatic stressor. The stressor usually involves being a part of or witnessing an event of horrific magnitude. The traditional symptoms of PTSD include:
- Nightmares of past traumatic events
- Triggers of physical and psychological stresses
- Avoidance of any reminders of similar stimuli
- Isolation from others
- Emotional numbing
- Outbursts of anger or irrational rage
- Problems in concentration and focus
- Hypervigilance for triggers or paranoid thinking
From a rational point of view, all these symptoms seem simple and straightforward, but they are not. There are few treatments that actually show documented benefit in healing PTSD.
Medications for depression and anxiety are usually the frontline treatment. Group therapy has also been a mainline approach, especially with the integration of desensitization techniques. But nothing so far has produced a cure.
The PTSD Nightmare
There are a daunting number of veterans with PTSD in this nation, with more than eight hundred thousand diagnosed and countless others who have not sought help as thousands of soldiers continue to return home from war. These numbers will cause a seismic shift in our society by the sheer economic cost of care and loss of human capital. This is our national burden, and it's our responsibility to help these men and women. It's also our responsibility to help the families of these soldiers.
The children of veterans with the diagnosis of PTSD are much more likely to have problems in school and trouble with legal boundaries. The experience of having one of your parents become dysfunctional is troublesome enough for a child, but to be emotionally cut off from affection and guidance in understanding your own mixed-up feelings about the world has to be considered as some level of neglect. With spouses suffering from mental health problems, family structures are strained and collapsing at an epidemic rate. PTSD is not just a problem among our soldiers and their families. PTSD is considered an anxiety reaction to trauma of any kind. It can truly happen to anyone.
Luci was brutally raped when she was just fifteen and is still having debilitating nightmares almost every night at age twenty-five. In public, she finds herself hiding from people in closets or nooks, anywhere she can find to feel safe. She is an attractive woman, yet she purposefully dresses poorly to keep men from approaching her. She tries to gorge herself with fattening food to make herself even more unattractive. Therapy is frustrating because she wants to forget the traumatic event, but it seems like the goal of the available therapies is to force her to relive the rape over and over so that she can process her fears about it.
Bill, age fifty-five, was losing sleep because every time he would get comfortable, his doctor's face and voice would invade his consciousness. His mind would immediately go back to the moment he was told he had cancer. When he could finally get some sleep with the help of medication, he would dream of horrible deaths and the nightmares would wake him. He is now afraid of all medical consultations, even those that might help him. He has lost his strong faith in God, feeling betrayed and bitter about these events. He wants to know why this is happening to him. Sometimes, in a fit of anger, he throws things at his wife or lashes out at friends just because they are healthy and happy. With the additional stress caused by PTSD, his immune system is being compromised, which will likely increase his cancer's growth.
Do these people sound like someone you know? Perhaps it is you, your spouse, or a friend. There is a one out of ten chance that you or someone you know will develop PTSD during your lifetime. It's twice as likely if you experience a significant trauma and three to four times as likely if you are involved in some kind of disaster.
It has been shown that the citizens of New York City had a 12.6 percent rate of PTSD due to their close association with the terrorist attack of 9/11. If they were directly involved at any level, the rate shot up to 38 percent. High rates of PTSD are found in professionals who deal with shock, such as trauma counselors, police, firemen, and case workers. And one of the largest populations of people with PTSD is, of course, our soldiers.
The saddest story of all is that, until now, there have been no significant medical approaches to the resolution of PTSD since the diagnosis came into use more than forty years ago. There simply have been no answers. And time is running out. On average, there are three deaths by suicide each day from veterans alone. More than one thousand attempt to end their lives every month. Although the armed forces count approximately five thousand casualties in recent wars, if you include these suicides and suicide attempts, the number would be closer to seventy thousand.
The two most common treatment approaches for PTSD, medicine and psychotherapy, are not working. Zoloft and Paxil are the only two medications that have been approved by the FDA for treatment of PTSD. But many believe they are contributing to the problem rather than helping it. The labels of these medications warn of a significant risk of suicide. Should we then be surprised that two out of every five veterans who commit suicide were taking these medications? The bottom line: Medication is not the answer.
The other option offered as a solution is psychotherapy. But like Luci, many people with PTSD are not ready to explore painful times again. They are already isolating themselves from their community, friends, and loved ones, so the last thing they want to do is sit in a closed-in office with a stranger for long periods of time. And as strange as it might sound, PTSD isn't cured by exploring feelings or even experiencing reminders of the horrible events that were undergone. These tactics are contraindicated in professional psychotherapy because they require the person to relive the painful event in his or her mind without proper preparation or the skill sets to manage the stress that follows. In spite of the research and poor outcomes, old practices are hard to change. This approach is not helpful, at least in the beginning, which is where we are right now.
So what is the solution to helping those with PTSD?