controversial title?

A story in the NYT (http://www.nytimes.com/2016/06/12/magazine/what-if-ptsd-is-more-physical-than-psychological.html) tells of some good research into PTSD and brain insults from combat.  Once again some thoughtful scientist-practitioners saw something that needed better understanding and did something about it.  They noticed that soldiers returning home reported two complexes of symptoms, one reflective of psychological trauma, i.e., PTSD, and one reflective of concussions, e.g. CTE.  After having researched concussions and their sequelae from sports injuries and with specialized brain imaging techniques and machines, they went to Iraq/Afghanistan to investigate.  They found that, although a mandated protocol, soldiers were not being assessed for concussions after experiencing close explosions and many soldiers were reluctant to report such symptoms both from their confusion with PTSD and from their fear of discrimination by their commanders.  The researchers met with resistance from the military medical community who minimized the effects and potential for longer term sequelae but Admiral Michael Mullins (now retired after being Chair of the Joint Chiefs) gave the researchers the power to follow through and even to design/implement new treatments and prevention.  They developed a small sensor that detected the pulsive force of explosions and turned red if acceptable limits were exceeded.  (These limits were the result of sports research and further experimentation).  If the badge is red, the soldier must report and the medical team must evaluate.  That’s the good news;  the bad news is that many soldiers, including some instructors who trained them how to explode doors open and handle other explosions, suffer from brain injury that can profoundly affect their life.

Now the controversial title is this:  “What if PTSD is more physical than psychological?”  Many commented on the fact that PTSD is physical, that it is a medical and psychiatric diagnosis, and that it is a brain disease.  Others responded that they understood all that but did not mind the title anyway.  I am closer to the first group.  The writers did say in the body of the article that PTSD was a brain disorder, and so we can assume it is physical.  But the title, while cute and catchy, perpetuates the belief that stress and shock and emotional trauma are not and do not cause physical phenomena.  This is still a widespread belief (“when will that person just get over the incident?”) of many in the general public and also, it seems, in military medical staff.

Much research has been done in the past 30 or more years to enhance our understanding of PTSD and its long term sequelae.  The only name I can remember right now is Bessel van der Kolk, who has done much to show that emotional trauma affects the brain both immediately and over the long term.  The characteristics of the trauma and the timeliness and expertise of any treatment cause great variation for any one instance.

When I practiced psychology I explained the effects of child maltreatment, characterizing the betrayal of trust in family violence, witnessed or experienced, sexual aggression, and sometimes parental behaviors reflecting the adults’ psychopathology as blows which bruised the child’s developing empathy for others and also for themselves.  The subsequent depression, anxiety, difficulties in emotional regulation and impulse control, even some difficulty understanding cause and effect or moral norms, were the effects of the traumatic bruising of brain areas involved in empathic or social-emotional processing.    The emotional maltreatment was a physical insult that bruised the developing brain in characteristic ways, ways that could affect their behavior some years later (think of 3 yr old being molested and consider when they reach adolescence).

So yes, the title miseducates, but the article is still a good one you might oughta read.  Travel on.

 

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