After experiencing a traumatic event, the mind has been known to horde away the
details and memories and then send them back at unexpected times and places,
sometimes after years have passed. It does so in a haunting way that makes the
recall just as disturbing as the original event. Post Traumatic Stress Disorder
is the name for the acquired mental condition that follows a psychologically
distressing event “outside the range of usual human experience”
(Bernstein, et al). There are five diagnostic criteria for this disorder and
there are no cures for this affliction, only therapies which lessen the burden
of the symptoms. The root of the disorder is a traumatic event which implants
itself so firmly in the mind that the person may be shackled by the pain and
distress of the event indeinately, experiencing it again and again as the mind
stays connected with the past rather than the present, making it difficult to
think of the future. The research on this topic is all rather recent as the
disorder was only added to the Diagnostic and Statistical Manual of Mental
Disorders (DSM-III) in the last twenty years. Yet, the disorder is quite common,
threatening to control and damage the lives of approximately eight percent of
the American population [5% of men and 10% of women]. Any person is a potential
candidate for developing PTSD if subject to enough stress. There is no predictor
or determining factor as to who will develop PTSD and who will not. Although all
people who suffer from it have experienced a traumatic event, not all people who
experience a traumatic event will develop PTSD. Each persons individual capacity
for coping with catastrophic events determines their risk of acquiring PTSD. And
not everyone will experience the same symptoms; some may suffer only a few mild
symptoms for a short period of time, others may be completely absorbed, still
others who experience great trauma may never develop any symptoms at all
(Friedman). More than any other psychological problem, symptoms are a reaction
to an overwhelming external event, or series of events. From a historical
perspective, the concept of PTSD made a significant change in the usual
stipulation that the cause of a disorder could be outside of the self, rather
than some inherent individual weakness (Friedman). There are many situations
that may lead to developing PTSD, including: “serious threats to one’s life
or well being, or to children, spouse or close friends/relatives; sudden
destruction of home or community; and witnessing the accidental or violent death
or injury of another” (Bernstein, et al). Characteristic symptoms include
re-experiencing the event, avoidance of stimuli associated with the event or
numbing of general responsiveness, increased arousal not present before the
event, and duration of the disturbance for at least one month (Johnson). When a
bomb exploded the Oklahoma Federal building in 1996, hundreds of lives were
affected. Not only are the people who were in the explosion in danger of
re-experiencing it over and over, but so are the people who witnessed the
aftermath, from bystanders to the rescue workers on scene. The surviving
employees not only were physically injured in the blast, but saw the deaths of
their coworkers and children. Surviving a horrific trauma that many others did
not is enough to cause serious emotional harm. For the rescue workers who
arrived, many of them saw death and people who they could not help; feeling
helpless and guilty may manifest into intrusive recollection and nightmares. To
explain further, the first criteria is that the person was at one time exposed
to a traumatic event involving actual or threatened death or injury, where the
response was marked by intense fear, horror or helplessness (Pfefferbaum). This
event may have taken place only weeks ago, or as far back in memory as forty
years. The disorder is most commonly found among survivors of war, abuse and
rape. It also occurs after assorted crime and car accidents, as well as after
community disasters such as hurricanes and floods. Workers of rescue missions
are subjected to situations of severe stress frequently. Many emergency response
workers (police, nurses, and medics) may become overwhelmed by the trauma they
see so many people go through and end up with intrusive recollections
themselves. Secondly, the trauma is re-experienced in the form of nightmares,
flashbacks, intrusive memories and/or unrest in situations that are similar to
the traumatic experience by an associated stimuli (Pfefferbaum). Auditory or
visual stimuli can evoke panic, terror, dread, grief or despair. Commonly, in
the case of war veterans, the patient may be mentally “sent back” to
the time and location of the original traumatic experience. A veteran who hears
a startling noise like a car backfiring may “hear” gunfire and it will
trigger flashbacks. These flashbacks can last a little as a few seconds,
minutes, or up to days where the person behaves and reacts to everything as if
they are in that original traumatizing setting. Thirdly, there is a numbing of
the emotions and reduced interests in others and the outside world. The person
is attempting to reduce the likelihood that they will either expose themselves
to traumatic stimuli or if exposed will minimize the intensity of their
psychological response (Pfefferbaum). For this reason, it is extremely difficult
for people with PTSD to participate in meaningful interpersonal relationships.
Forth, there are random associated symptoms including insomnia, irritability,
hypervigilance and outbursts of rage. The natural startle inhibitor may be
dulled and the patient is easily surprised or upset by unexpected stimuli.
Lastly, symptoms of each category must show significant affect on the person’s
social/vocational abilities or other important areas of life. Which appears to
be an unavoidable effect if a person is in fact experiencing the symptoms
listed. All of these symptoms must persist for at least one month An example
from the textbook Psychology introduces a 33-year-old nurse named Mary who
suffered severe trauma in the weeks following an attack in her apartment by an
intruder who raped her at knife point (Criterion one). In the weeks after the
attack Mary suffered from an immense fear of being alone in her apartment (the
second criterion), and preoccupied with attack, she feared it could happen
again. Her worry developed in to an obsession with protection and she installed
numerous locks on all her windows and doors, eventually Mary became so overly
preoccupied with the attack that she could no longer go out socially or even
return to work (Criterion three and five). She became repelled by the idea of
sex. Her associated behaviors encompass criterion four. In the seven years since
the Gulf War, three percent of United States Soldiers have so far been diagnosed
as having Posttraumatic Stress Syndrome. Those with greatest exposure to combat
are the most likely sufferers, which lends to the idea that the more severe a
traumatic event are more difficult it is to overcome. Additionally it develops
predominantly in soldiers who were categorized as having the least “stress
resistant personalities” coupled with low levels of social support.
Essential to recovery of any stressful event is the knowledge that the sufferer
is not alone or unique in the grief and that others care about his or her
recovery. Those soldiers who returned from war with no one to share their
experiences with are likely to re experience warfare in the form of nightmares
and flashbacks. After witnessing the deaths of both enemies and comrades those
without social support are likely to internalize their pain which have a good
chance of escaping out of the body in the symptoms listed (Bernstein).
“Acute” PTSD occurs within six months of the traumatic event, while
“Delayed On-set” PTSD occurs anytime afterwards. In some instances,
patients have developed symptoms decades later. Holocaust survivors,
experiencing terrifying nightmares of events they thought they had buried so
long ago, have been diagnosed forty and fifty years after the attempted genocide
of the Jews with PTSD. PTSD can become a chronic psychiatric disorder that can
persist for decades and sometimes a lifetime. Chronic patients go through
periods of remission and relapse like many diseases. Some problems associated
with leaving PTSD untreated are clinical depression and addictions, such as
alcoholism, drug abuse, and compulsive gambling. Addictions are a common way of
“self-medicating.” There are instances when a person suffers from
involuntary recall of events that they cant quite place or understand. Sometimes
adults who were abused in some form as children do not fully know what is
tormenting them but still struggle with similar symptoms. For these people
hypnosis in a controlled environment is beneficial. After hypnosis the patient
and doctor will discuss what has come out and together deal with what has been
learned. Drugs in general are not a cure for Post Traumatic Stress Disorder, but
they can calm the patient long enough to rationally discuss what is torturing
them. Also it is possible that children who survived the Oklahoma bomb blast may
not be told for some time what they lived through. Their first recollections may
be hazy pictures that only hint as to what happened. Hypnosis may bring out the
details that the mind isn’t willingly sharing. When the details are known the
patient then has the opportunity to accept them and develop an understanding and
an acceptance (if they are lucky enough to get that far) of what they have
survived (Foy). Therapy is the only known method of treatment, but there have
not been substantial gains in this field for recovery of patients. After four
months of intensive treatment, Vietnam veterans showed no long term effects of
their therapy in a study conducted by the “National Center for
Post-Traumatic Stress Disorder” in New Haven. The men received individual
and group psychotherapy and behavior therapy as well as family therapy and
vocational guidance. Although they left reporting increased hope and
self-esteem, a year and a half later their psychiatric symptoms had actually
worsened. They had made more suicide attempts and their substance abuse was
dramatically increased (Johnson). The Harvard Mental Health Letter published
February/March of 1991 asserts the important result of therapy (of any kind) is
the enabling of the patient to think about the trauma without it taking over and
being able to control their feelings without systematically avoiding or
diverting their attention. People who are afflicted with PTSD never feel safe
because they are controlled by their fears; nightmares and flashbacks only
confirm their perceived helplessness and remind them of how they were unable to
protect themselves from the event. Healing has taken place only when the person
can invoke and dismiss the memories at will, instead of suffering the intrusive
involuntary recall (Johnson).
Bibliography
Bernstein, Douglas A., Alison Clarke-Stewart, Edward Roy, Christopher D.
Wickens. Psychology. Boston: Houghton Mifflin Company, 1997 Bower, Bruce.
“Exploring trauma’s cerebral side.” Science News. 149.20 (1996) : 315
Foy, David W., ed. Treating PTSD : cognitive-behavioral strategies. New York:
Guilford Press, 1992. Friedman, Matthew J. “Post Traumatic Stress Disorder:
An Overview.” National Center for PTSD. Dartmouth Medical School, 1997.
Johnson, David R., Robert Rosenheck, Alan Fontana. “Post-traumatic
treatment failure.” Harvard Mental Health Letter. 13.9 (1997) : 7 Matsakis,
Aphrodite. I Can’t Get Over It : a handbook for trauma survivors. Oakland.: New
Harbinger Publications, Inc., 1996. Pfefferbaum, Betty. “Posttraumatic
stress disorder in children: a review of the past ten years.” Journal of
the American Academy of Child and Adolescent Psychiatry. 36.11 (1997) : 1503-12
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14 Oct 1998. Available. http://www.mentalhealth.com/mag1/p5h-pts2.html
